Re: Disagree with answers given

[Guest guest]

The arthritis foundation lists MTX as a modifier only. This is why it is called a DMARD. Check www.arthritisfoundation.org for more information. Hugs, Deborah

On 7/6/06, snowdrift52003 <snowdrift52003@...> wrote:

>

> Dear Kathy- Remember that MTX modifies the disease but does not halt

the progression of the disease... A biologic should be started to ease

your symptoms and stop the progression.

MTX can indeed halt progression. Biolgoic meds can be very hepful, but

they also carry significant risks. Only a rheumatologist can effetively

assess the risk/benefit ratio for the individual.

-Sierra

[Guest guest]

From Arthritis Foundation at http://www.arthritis.org/conditions/DrugGuide/types.asp

“Biologic Response Modifiers

Biologic agents were once reserved for people who's rheumatoid arthritis symptoms

failed to respond to other therapies. Now these agents are benefiting more

people in ways that weren't originally anticipated.

“DMARDs

Disease-modifying antirheumatic drugs (DMARDs) may actually modify the course

of inflammatory conditions, slowing or perhaps even stopping their progression.”

The way I read this it agrees with Sierra by quoting the

group cited by Deborah. In my opinion biologics are just a special (and

expensive) class of DMARDs. It took a biologic for me to control my RA

but others get control with the older DMARDs because we are all different.

From: Rheumatoid Arthritis [mailto:Rheumatoid Arthritis ] On Behalf Of Deborah Bargad

Sent: Thursday, July 06, 2006

12:59 PM

Rheumatoid Arthritis

Subject: Re:

Disagree with answers given

The arthritis foundation lists MTX as a modifier

only. This is why it is called a DMARD. Check www.arthritisfoundation.org for

more information. Hugs, Deborah

On 7/6/06, snowdrift52003

<snowdrift52003@...>

wrote:

>

> Dear Kathy- Remember that MTX modifies the disease but does not halt

the progression of the disease... A biologic should be started to ease

your symptoms and stop the progression.

MTX can indeed halt progression. Biolgoic meds can be very hepful, but

they also carry significant risks. Only a rheumatologist can effetively

assess the risk/benefit ratio for the individual.

-Sierra

[Guest guest]

Actually, people do use both. One of the things about the biologics is that at least with the case on enbrel they work better when combined with methotrexate.

I take the dmard sulfasalazine, as well as methotrexate and enbrel (switching to orencia for insurance reasons).

It isn’t quite correct to look at biologics as just a newer kind of dmards. They work differently than the older dmards do.

From: Harold Van Tuyl <hvantuyl@...>

Reply- " Rheumatoid Arthritis " <Rheumatoid Arthritis >

Date: Thu, 6 Jul 2006 13:21:48 -0700

<Rheumatoid Arthritis >

Subject: RE: Disagree with answers given

From Arthritis Foundation at http://www.arthritis.org/conditions/DrugGuide/types.asp

“Biologic Response Modifiers <http://www.arthritis.org/conditions/DrugGuide/about_brms.asp>

Biologic agents were once reserved for people who's rheumatoid arthritis symptoms failed to respond to other therapies. Now these agents are benefiting more people in ways that weren't originally anticipated.

“DMARDs <http://www.arthritis.org/conditions/DrugGuide/about_dmards.asp>

Disease-modifying antirheumatic drugs (DMARDs) may actually modify the course of inflammatory conditions, slowing or perhaps even stopping their progression.”

The way I read this it agrees with Sierra by quoting the group cited by Deborah. In my opinion biologics are just a special (and expensive) class of DMARDs. It took a biologic for me to control my RA but others get control with the older DMARDs because we are all different.

From: Rheumatoid Arthritis [mailto:Rheumatoid Arthritis ] On Behalf Of Deborah Bargad

Sent: Thursday, July 06, 2006 12:59 PM

Rheumatoid Arthritis

Subject: Re: Disagree with answers given

The arthritis foundation lists MTX as a modifier only. This is why it is called a DMARD. Check www.arthritisfoundation.org <http://www.arthritisfoundation.org> for more information. Hugs, Deborah

On 7/6/06, snowdrift52003 <snowdrift52003@...> wrote:

>

> Dear Kathy- Remember that MTX modifies the disease but does not halt

the progression of the disease... A biologic should be started to ease

your symptoms and stop the progression.

MTX can indeed halt progression. Biolgoic meds can be very hepful, but

they also carry significant risks. Only a rheumatologist can effetively

assess the risk/benefit ratio for the individual.

-Sierra

[Guest guest]

The drug " May " help doesnt not mean it " Will " help. This article provides more details. Some people do find relief with MTX alone but this is not a vast majority. Hugs, Deborah

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=11409154 & dopt=Abstract

On 7/6/06, Gwen Orel <gwenorel@...> wrote:

Actually, people do use both. One of the things about the biologics is that at least with the case on enbrel they work better when combined with methotrexate.

I take the dmard sulfasalazine, as well as methotrexate and enbrel (switching to orencia for insurance reasons).It isn't quite correct to look at biologics as just a newer kind of dmards. They work differently than the older dmards do.

From: Harold Van Tuyl <hvantuyl@...>Reply- "

Rheumatoid Arthritis " <Rheumatoid Arthritis >

Date: Thu, 6 Jul 2006 13:21:48 -0700

<Rheumatoid Arthritis >

Subject: RE: Disagree with answers given

From Arthritis Foundation at http://www.arthritis.org/conditions/DrugGuide/types.asp

"Biologic Response Modifiers

<http://www.arthritis.org/conditions/DrugGuide/about_brms.asp>

Biologic agents were once reserved for people who's rheumatoid arthritis symptoms failed to respond to other therapies. Now these agents are benefiting more people in ways that weren't originally anticipated.

"DMARDs

<http://www.arthritis.org/conditions/DrugGuide/about_dmards.asp>

Disease-modifying antirheumatic drugs (DMARDs) may actually modify the course of inflammatory conditions, slowing or perhaps even stopping their progression." The way I read this it agrees with Sierra by quoting the group cited by Deborah. In my opinion biologics are just a special (and expensive) class of DMARDs. It took a biologic for me to control my RA but others get control with the older DMARDs because we are all different.

From:

Rheumatoid Arthritis [mailto:Rheumatoid Arthritis ] On Behalf Of Deborah BargadSent: Thursday, July 06, 2006 12:59 PMRheumatoid Arthritis

Subject: Re: Disagree with answers given

The arthritis foundation lists MTX as a modifier only. This is why it is called a DMARD. Check www.arthritisfoundation.org

<http://www.arthritisfoundation.org> for more information. Hugs, Deborah

On 7/6/06, snowdrift52003 <

snowdrift52003@...> wrote:

>> Dear Kathy- Remember that MTX modifies the disease but does not halt the progression of the disease... A biologic should be started to ease your symptoms and stop the progression. MTX can indeed halt progression. Biolgoic meds can be very hepful, but they also carry significant risks. Only a rheumatologist can effetively assess the risk/benefit ratio for the individual.-Sierra

[Guest guest]

I see a Rheumatologist who is in a group practice with three other Rheumatologists, and there are seven or eight more in the immediate area. Obviously, there is a good selection, even within the practice I use. It's well-established and has been in existence for quite some time. My doctor is conservative when it comes to medications, but aggressive in treating early RA. I had an appointment yesterday and we discussed my meds(plaquenil) and either decreasing it to see if it really is effective, or changing to another med. I decided to do a decrease first. My RA appears to follow the pattern of severe swelling/pain, lasting for well over a year in specific joints, and then "burning out," with little deformity and joint damage. As he said, he can't predict what will happen with each joint, but this appears to have been a consistent pattern over the last fifteen years. I'm having a lot of trouble with my hands now and we're giving it another six months to see if the same thing happens. Hopefully, it will.

Now, my point<g>. Several of you answer most posts from newer people and "recommend" a huge drug cocktail consisting of mostly biologics. Every single one of these medications, as well as the traditional dmards, has side-effects, and some of them are life-threatening. I'm not saying that we shouldn't be using them, but I do think that we need to balance our pain/discomfort with the potential side-effect of any medication we take. There is also the possibility that inflammation may recede on its own, or with naproxin/prednisone combination. There's been some research showing that a steroid injection in one finger will sometimes alleviate swelling in the other fingers on the same hand, and there's also some indication that it has more of an effect in "stopping" the disease process than previously thought. The injections in specific small joints like that also do not have the bone-thinning effect that they do when given as a general infection or pill form. And yes, they HURT, but only for a moment.

Anyway, meds are a serious thing, and anything you put into your body is going to have an effect. As a side note: I just spent the last year with my best friend, who died recently in hospice(appendoceal cancer). She was totally addicted to oxycodone and dilaudid, and even though it was prescribed for pain, the addiction was there and was a factor that greatly affected what little quality of life she had left. Being in pain has little or nothing to do with developing an addiction to painkillers. It happens, and denying it or ignoring obvious symtoms and rationalizing are all part of the addiction. These are not things to be taken lightly, and once addicted, you quickly build up a drug tolerance again when resuming the medication after a hiatus. Addiction medicine is a whole field in itself, and doctors who tell you that you cannot become addicted if you have "real pain" know little or nothing about addiction. It has nothing to do with how much pain you have, but instead, with how much medication you take and for how long. Physical addiction progresses very quickly to psychological addiction, and that's where you completely lose perspective. That's why we have pain clinics -- continuous narcotics for pain are never the answer unless you are terminal. You cannot maintain for years on the same dosage of a narcotic and get the same pain relief. Eventually you will get to the point where your body tolerates and has adjusted to the highest dosage possible, and still have pain. These drugs are never an "answer," but rather a bridge to a more permanent form of pain control.

----- Original Message -----

From: Deborah Bargad

Rheumatoid Arthritis

Sent: Friday, July 07, 2006 3:57 AM

Subject: Re: Disagree with answers given

The drug "May" help doesnt not mean it "Will" help. This article provides more details. Some people do find relief with MTX alone but this is not a vast majority. Hugs, Deborah http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=11409154 & dopt=Abstract

On 7/6/06, Gwen Orel <gwenorel@...> wrote:

Actually, people do use both. One of the things about the biologics is that at least with the case on enbrel they work better when combined with methotrexate. I take the dmard sulfasalazine, as well as methotrexate and enbrel (switching to orencia for insurance reasons).It isn't quite correct to look at biologics as just a newer kind of dmards. They work differently than the older dmards do.

From: Harold Van Tuyl <hvantuyl@...>Reply-" Rheumatoid Arthritis " <Rheumatoid Arthritis >Date: Thu, 6 Jul 2006 13:21:48 -0700

<Rheumatoid Arthritis >

Subject: RE: Disagree with answers given

From Arthritis Foundation at http://www.arthritis.org/conditions/DrugGuide/types.asp

"Biologic Response Modifiers <http://www.arthritis.org/conditions/DrugGuide/about_brms.asp>

Biologic agents were once reserved for people who's rheumatoid arthritis symptoms failed to respond to other therapies. Now these agents are benefiting more people in ways that weren't originally anticipated.

"DMARDs <http://www.arthritis.org/conditions/DrugGuide/about_dmards.asp>

Disease-modifying antirheumatic drugs (DMARDs) may actually modify the course of inflammatory conditions, slowing or perhaps even stopping their progression." The way I read this it agrees with Sierra by quoting the group cited by Deborah. In my opinion biologics are just a special (and expensive) class of DMARDs. It took a biologic for me to control my RA but others get control with the older DMARDs because we are all different.

From: Rheumatoid Arthritis [mailto:Rheumatoid Arthritis ] On Behalf Of Deborah BargadSent: Thursday, July 06, 2006 12:59 PMRheumatoid Arthritis Subject: Re: Disagree with answers given

The arthritis foundation lists MTX as a modifier only. This is why it is called a DMARD. Check www.arthritisfoundation.org <http://www.arthritisfoundation.org> for more information. Hugs, Deborah

On 7/6/06, snowdrift52003 < snowdrift52003@...> wrote:

>> Dear Kathy- Remember that MTX modifies the disease but does not halt the progression of the disease... A biologic should be started to ease your symptoms and stop the progression. MTX can indeed halt progression. Biolgoic meds can be very hepful, but they also carry significant risks. Only a rheumatologist can effetively assess the risk/benefit ratio for the individual.-Sierra

[Guest guest]

you havea lot of chutzpah lecturing people about the downsides of medicine from

the standpoint of someone with as you describe " no permanaent damage " ! I've had

to have all my mcp joints replaced due to damage and I was going to be a

violinist

when I was growing up physicians took the " conservative " approach... I have had

this disease since age 14 and am now 41. I have had a LOT of time to weight the

pros and cons and have been on every med out there... Including plaquenil which

did not halt progres for me. I wish there had been biologics 20 years ago.

Forgive me but your disease is just not as virulent as others here and by

counseling a " conservative " approach you could be doing a LOT of harm. For most

people " waiting for a flare to pass on its own " WILL lead to irreperable joint

damage. I wish you could see my x rays or give me back my music career. You

mean well but you are not a physician and by throwing around scare tactics

aboutmeds and suggesting the cure is worse than the illness you are

irresponsible. Andi also have certainly experienced loads of side effects. My

point is that for most of us RA is a VERY serious illness and finding the right

med or meds is a priority not a step on the road to addi!

ction. Please don't judge those of us who need that " cocktail " or imply that WE

and not our physicians created it.

Gwen

(methotrexate, prednisone, biologic, azulfidine)

Sent from my treo

-----Original Message-----

From: " LH " <saludo@...>

Subj: Re: Disagree with answers given

Date: Fri Jul 7, 2006 10:03 am

Size: 4K

<Rheumatoid Arthritis >

I see a Rheumatologist who is in a group practice with three other

Rheumatologists, and there are seven or eight more in the immediate area.

Obviously, there is a good selection, even within the practice I use. It's

well-established and has been in existence for quite some time. My doctor is

conservative when it comes to medications, but aggressive in treating early RA.

I had an appointment yesterday and we discussed my meds(plaquenil) and either

decreasing it to see if it really is effective, or changing to another med. I

decided to do a decrease first. My RA appears to follow the pattern of severe

swelling/pain, lasting for well over a year in specific joints, and then

" burning out, " with little deformity and joint damage. As he said, he can't

predict what will happen with each joint, but this appears to have been a

consistent pattern over the last fifteen years. I'm having a lot of trouble with

my hands now and we're giving it another six months to see if the same thing!

happens. Hopefully, it will.

Now, my point<g>. Several of you answer most posts from newer people and

" recommend " a huge drug cocktail consisting of mostly biologics. Every single

one of these medications, as well as the traditional dmards, has side-effects,

and some of them are life-threatening. I'm not saying that we shouldn't be using

them, but I do think that we need to balance our pain/discomfort with the

potential side-effect of any medication we take. There is also the possibility

that inflammation may recede on its own, or with naproxin/prednisone

combination. There's been some research showing that a steroid injection in one

finger will sometimes alleviate swelling in the other fingers on the same hand,

and there's also some indication that it has more of an effect in " stopping " the

disease process than previously thought. The injections in specific small joints

like that also do not have the bone-thinning effect that they do when given as a

general infection or pill form. And yes, they HURT!

, but only for a moment.

Anyway, meds are a serious thing, and anything you put into your body is going

to have an effect. As a side note: I just spent the last year with my best

friend, who died recently in hospice(appendoceal cancer). She was totally

addicted to oxycodone and dilaudid, and even though it was prescribed for pain,

the addiction was there and was a factor that greatly affected what little

quality of life she had left. Being in pain has little or nothing to do with

developing an addiction to painkillers. It happens, and denying it or ignoring

obvious symtoms and rationalizing are all part of the addiction. These are not

things to be taken lightly, and once addicted, you quickly build up a drug

tolerance again when resuming the medication after a hiatus. Addiction medicine

is a whole field in itself, and doctors who tell you that you cannot become

addicted if you have " real pain " know little or nothing about addiction. It has

nothing to do with how much pain you have, but instead, wi!

th how much medication you take and for how long. Physical addiction progresses

very quickly to psychological addiction, and that's where you completely lose

perspective. That's why we have pain clinics -- continuous narcotics for pain

are never the answer unless you are terminal. You cannot maintain for years on

the same dosage of a narcotic and get the same pain relief. Eventually you will

get to the point where your body tolerates and has adjusted to the highest

dosage possible, and still have pain. These drugs are never an " answer, " but

rather a bridge to a more permanent form of pain control.

----- Original Message -----

From: Deborah Bargad

Rheumatoid Arthritis

Sent: Friday, July 07, 2006 3:57 AM

Subject: Re: Disagree with answers given

The drug " May " help doesnt not mean it " Will " help. This article provides

more details. Some people do find relief with MTX alone but this is not a vast

majority. Hugs, Deborah

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

1409154 & dopt=Abstract

On 7/6/06, Gwen Orel <gwenorel@...> wrote:

Actually, people do use both. One of the things about the biologics is that

at least with the case on enbrel they work better when combined with

methotrexate.

I take the dmard sulfasalazine, as well as methotrexate and enbrel

(switching to orencia for insurance reasons).

It isn't quite correct to look at biologics as just a newer kind of dmards.

They work differently than the older dmards do.

--- message truncated ---

[Guest guest]

Gwen,

I am NOT counseling a "conservative" approach; my point(which probably wasn't clear) was that heavy drug cocktails are not always the first choice for treatment, and that whatever we choose, we should be very aware of the side-effects and weigh them against the consequences of not treating the disease. I would never say that anyone with joint damage or in pain should forego drugs for any reason. What I *am* counseling is AWARENESS. Many new people join this list and are told to ask their doctors for heavy meds immediately. All I'm saying is that we need to be careful of that. I could have been in the same position fifteen years ago -- I was in severe pain, could hardly walk, and was terrified. For a variety of reasons, I'm much better now, although it's been a slow, painful progress. Fifteen years ago we didn't have some of these biologics, but for myself, I'm glad we didn't, because I would have opted for them immediately.

You, very obviously, are not a new person with initial symptoms of RA. You've had it for many years, tried whatever there was to try, and are informed. The great majority of new people on this list are not. They have no idea what's out there and when told to ask for specific meds from their doctors, can easily fall into trusting that recommendation because it's from someone who has "been there." Rather than "playing doctor" with people, I'm asking that we do NOT do that. Sharing our own experience might be a better way to go than recommending that people use certain things. I haven't had to go further yet into available treatments, but that doesn't mean that I won't have to. My mother was crippled up before she died because she refused all treatment; she had joint damage and immobility, and I could easily follow that same path. I *know* how lucky I am; I don't forget that for a minute. Every day of the last fifteen years has been a gift that I'm grateful for. I don't recommend that anyone not get treated or take meds -- I DO recommend that they do their own research, weigh the side effects, and talk with their own doctors.

----- Original Message -----

From: gwenorel@...

Rheumatoid Arthritis

Sent: Friday, July 07, 2006 10:14 AM

Subject: Re: Disagree with answers given

you havea lot of chutzpah lecturing people about the downsides of medicine from the standpoint of someone with as you describe "no permanaent damage"! I've had to have all my mcp joints replaced due to damage and I was going to be a violinistwhen I was growing up physicians took the "conservative" approach... I have had this disease since age 14 and am now 41. I have had a LOT of time to weight the pros and cons and have been on every med out there... Including plaquenil which did not halt progres for me. I wish there had been biologics 20 years ago. Forgive me but your disease is just not as virulent as others here and by counseling a "conservative" approach you could be doing a LOT of harm. For most people "waiting for a flare to pass on its own" WILL lead to irreperable joint damage. I wish you could see my x rays or give me back my music career. You mean well but you are not a physician and by throwing around scare tactics aboutmeds and suggesting the cure is worse than the illness you are irresponsible. Andi also have certainly experienced loads of side effects. My point is that for most of us RA is a VERY serious illness and finding the right med or meds is a priority not a step on the road to addi!ction. Please don't judge those of us who need that "cocktail" or imply that WE and not our physicians created it.Gwen(methotrexate, prednisone, biologic, azulfidine)Sent from my treo-----Original Message-----From: "LH" <saludoFUSE (DOT) NET>Subj: Re: Disagree with answers givenDate: Fri Jul 7, 2006 10:03 amSize: 4K<Rheumatoid Arthritis >I see a Rheumatologist who is in a group practice with three other Rheumatologists, and there are seven or eight more in the immediate area. Obviously, there is a good selection, even within the practice I use. It's well-established and has been in existence for quite some time. My doctor is conservative when it comes to medications, but aggressive in treating early RA. I had an appointment yesterday and we discussed my meds(plaquenil) and either decreasing it to see if it really is effective, or changing to another med. I decided to do a decrease first. My RA appears to follow the pattern of severe swelling/pain, lasting for well over a year in specific joints, and then "burning out," with little deformity and joint damage. As he said, he can't predict what will happen with each joint, but this appears to have been a consistent pattern over the last fifteen years. I'm having a lot of trouble with my hands now and we're giving it another six months to see if the same thing!happens. Hopefully, it will.Now, my point<g>. Several of you answer most posts from newer people and "recommend" a huge drug cocktail consisting of mostly biologics. Every single one of these medications, as well as the traditional dmards, has side-effects, and some of them are life-threatening. I'm not saying that we shouldn't be using them, but I do think that we need to balance our pain/discomfort with the potential side-effect of any medication we take. There is also the possibility that inflammation may recede on its own, or with naproxin/prednisone combination. There's been some research showing that a steroid injection in one finger will sometimes alleviate swelling in the other fingers on the same hand, and there's also some indication that it has more of an effect in "stopping" the disease process than previously thought. The injections in specific small joints like that also do not have the bone-thinning effect that they do when given as a general infection or pill form. And yes, they HURT!, but only for a moment. Anyway, meds are a serious thing, and anything you put into your body is going to have an effect. As a side note: I just spent the last year with my best friend, who died recently in hospice(appendoceal cancer). She was totally addicted to oxycodone and dilaudid, and even though it was prescribed for pain, the addiction was there and was a factor that greatly affected what little quality of life she had left. Being in pain has little or nothing to do with developing an addiction to painkillers. It happens, and denying it or ignoring obvious symtoms and rationalizing are all part of the addiction. These are not things to be taken lightly, and once addicted, you quickly build up a drug tolerance again when resuming the medication after a hiatus. Addiction medicine is a whole field in itself, and doctors who tell you that you cannot become addicted if you have "real pain" know little or nothing about addiction. It has nothing to do with how much pain you have, but instead, wi!th how much medication you take and for how long. Physical addiction progresses very quickly to psychological addiction, and that's where you completely lose perspective. That's why we have pain clinics -- continuous narcotics for pain are never the answer unless you are terminal. You cannot maintain for years on the same dosage of a narcotic and get the same pain relief. Eventually you will get to the point where your body tolerates and has adjusted to the highest dosage possible, and still have pain. These drugs are never an "answer," but rather a bridge to a more permanent form of pain control. ----- Original Message ----- From: Deborah Bargad Rheumatoid Arthritis Sent: Friday, July 07, 2006 3:57 AMSubject: Re: Disagree with answers givenThe drug "May" help doesnt not mean it "Will" help. This article provides more details. Some people do find relief with MTX alone but this is not a vast majority. Hugs, Deborah http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=11409154 & dopt=AbstractOn 7/6/06, Gwen Orel <gwenorelcomcast (DOT) net> wrote: Actually, people do use both. One of the things about the biologics is that at least with the case on enbrel they work better when combined with methotrexate. I take the dmard sulfasalazine, as well as methotrexate and enbrel (switching to orencia for insurance reasons).It isn't quite correct to look at biologics as just a newer kind of dmards. They work differently than the older dmards do. --- message truncated ---

[Guest guest]

On the other side of the coin is the case

of aggressive RA that can cause permanent joint damage in the time it takes for

the body to adjust to an aggressive treatment and slow the progression of

RA. For those people if they use only mild medications they will have permanent

adverse consequences. If you wait for damage to appear before beginning

aggressive treatment it may result in bad deformities. A competent

rheumatologist will make a judgment of the severity of the disease and

recommend treatment accordingly. Either someone who always starts

aggressively or someone who always delays aggressive treatment should (in my

opinion) be avoided. We are all different and need individual treatment

depending on all the facts.

I think most people who come to a board

like this have fairly aggressive RA and need aggressive treatment – but obviously

there are exceptions. That is why a competent board-certified

rheumatologist (and if in doubt, a second opinion) is so necessary. God

bless.

From: Rheumatoid Arthritis [mailto:Rheumatoid Arthritis ] On Behalf Of LH

Sent: Friday, July 07, 2006 6:48

AM

Rheumatoid Arthritis

Subject: Re:

Disagree with answers given

I see a

Rheumatologist who is in a group practice with three other Rheumatologists, and

there are seven or eight more in the immediate area. Obviously, there is a good

selection, even within the practice I use. It's well-established and has

been in existence for quite some time. My doctor is conservative when it

comes to medications, but aggressive in treating early RA. I had an appointment

yesterday and we discussed my meds(plaquenil) and either decreasing it to see

if it really is effective, or changing to another med. I decided to do a

decrease first. My RA appears to follow the pattern of severe swelling/pain,

lasting for well over a year in specific joints, and then " burning

out, " with little deformity and joint damage. As he said, he can't predict

what will happen with each joint, but this appears to have been a consistent

pattern over the last fifteen years. I'm having a lot of trouble with my hands

now and we're giving it another six months to see if the same thing happens.

Hopefully, it will.

Now, my

point<g>. Several of you answer most posts from newer people and

" recommend " a huge drug cocktail consisting of mostly biologics.

Every single one of these medications, as well as the traditional dmards, has

side-effects, and some of them are life-threatening. I'm not saying that we

shouldn't be using them, but I do think that we need to balance our

pain/discomfort with the potential side-effect of any medication we take.

There is also the possibility that inflammation may recede on its own, or with

naproxin/prednisone combination. There's been some research showing that a

steroid injection in one finger will sometimes alleviate swelling in the other

fingers on the same hand, and there's also some indication that it has more of

an effect in " stopping " the disease process than previously thought.

The injections in specific small joints like that also do not have the

bone-thinning effect that they do when given as a general infection or pill

form. And yes, they HURT, but only for a moment.

Anyway, meds are a

serious thing, and anything you put into your body is going to have an effect.

As a side note: I just spent the last year with my best friend, who died

recently in hospice(appendoceal cancer). She was totally addicted to oxycodone

and dilaudid, and even though it was prescribed for pain, the addiction was

there and was a factor that greatly affected what little quality of life she

had left. Being in pain has little or nothing to do with developing an

addiction to painkillers. It happens, and denying it or ignoring obvious

symtoms and rationalizing are all part of the addiction. These are not

things to be taken lightly, and once addicted, you quickly build up a drug

tolerance again when resuming the medication after a hiatus. Addiction

medicine is a whole field in itself, and doctors who tell you that you cannot

become addicted if you have " real pain " know little or nothing about

addiction. It has nothing to do with how much pain you have, but instead, with

how much medication you take and for how long. Physical addiction progresses

very quickly to psychological addiction, and that's where you completely lose

perspective. That's why we have pain clinics -- continuous narcotics for

pain are never the answer unless you are terminal. You cannot maintain for

years on the same dosage of a narcotic and get the same pain relief. Eventually

you will get to the point where your body tolerates and has adjusted to the

highest dosage possible, and still have pain. These drugs are never an

" answer, " but rather a bridge to a more permanent form of pain

control.

----- Original Message -----

From: Deborah Bargad

Rheumatoid Arthritis

Sent: Friday, July 07,

2006 3:57 AM

Subject: Re:

Disagree with answers given

The drug " May " help doesnt not mean it

" Will " help. This article provides more details. Some

people do find relief with MTX alone but this is not a vast majority.

Hugs, Deborah http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=11409154 & dopt=Abstract

On 7/6/06, Gwen Orel

<gwenorel@...> wrote:

Actually, people do use both.

One of the things about the biologics is that at least with the case on

enbrel they work better when combined with methotrexate.

I take the dmard sulfasalazine, as well as methotrexate and enbrel (switching

to orencia for insurance reasons).

It isn't quite correct to look at biologics as just a newer kind of dmards.

They work differently than the older dmards do.

From: Harold

Van Tuyl <hvantuyl@...>

Reply- " Rheumatoid Arthritis "

<Rheumatoid Arthritis >

Date: Thu, 6 Jul 2006 13:21:48

-0700

<Rheumatoid Arthritis >

Subject:

RE: Disagree with answers given

From Arthritis Foundation

at http://www.arthritis.org/conditions/DrugGuide/types.asp

" Biologic Response Modifiers <http://www.arthritis.org/conditions/DrugGuide/about_brms.asp>

Biologic agents were once reserved for people who's rheumatoid

arthritis symptoms failed to respond to other therapies. Now these agents are

benefiting more people in ways that weren't originally anticipated.

" DMARDs <http://www.arthritis.org/conditions/DrugGuide/about_dmards.asp>

Disease-modifying antirheumatic drugs (DMARDs) may actually

modify the course of inflammatory conditions, slowing or perhaps even stopping

their progression. "

The way I read this it agrees with Sierra by quoting the group

cited by Deborah. In my opinion biologics are just a special (and

expensive) class of DMARDs. It took a biologic for me to control my RA

but others get control with the older DMARDs because we are all different.

From: Rheumatoid Arthritis

[mailto:Rheumatoid Arthritis ]

On Behalf Of Deborah Bargad

Sent: Thursday, July

06, 2006 12:59 PM

Rheumatoid Arthritis

Subject: Re:

Disagree with answers given

The arthritis foundation lists MTX as a modifier only. This

is why it is called a DMARD. Check www.arthritisfoundation.org

<http://www.arthritisfoundation.org>

for more information. Hugs, Deborah

On 7/6/06, snowdrift52003

<

snowdrift52003@...> wrote:

>

> Dear Kathy- Remember that MTX modifies the disease but does

not halt

the progression of the disease... A biologic should be started to

ease

your symptoms and stop the progression.

MTX can indeed halt progression. Biolgoic meds can be very

hepful, but

they also carry significant risks. Only a rheumatologist can

effetively

assess the risk/benefit ratio for the individual.

-Sierra

[Guest guest]

I have not seen any information about any

drug, combination of drugs, or other treatment that will help every person with

RA. Some have food sensitivities and benefit greatly from change of

diet. Others benefit from antibiotic therapy. Some benefit from

Chinese medicine. However, from what I have seen the greatest number

benefit from Western medicine, but which medicine varies from person to

person. We are all different and we need to experiment to see what works

for us. God bless.

From: Rheumatoid Arthritis [mailto:Rheumatoid Arthritis ] On Behalf Of Deborah Bargad

Sent: Friday, July 07, 2006 12:57

AM

Rheumatoid Arthritis

Subject: Re:

Disagree with answers given

The drug " May " help doesnt not mean it

" Will " help. This article provides more details. Some

people do find relief with MTX alone but this is not a vast majority.

Hugs, Deborah http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=11409154 & dopt=Abstract

On 7/6/06, Gwen Orel

<gwenorel@...> wrote:

Actually, people do use both.

One of the things about the biologics is that at least with the case on

enbrel they work better when combined with methotrexate.

I take the dmard sulfasalazine, as well as methotrexate and enbrel (switching

to orencia for insurance reasons).

It isn't quite correct to look at biologics as just a newer kind of dmards.

They work differently than the older dmards do.

From: Harold

Van Tuyl <hvantuyl@...>

Reply- "

Rheumatoid Arthritis " <Rheumatoid Arthritis >

Date: Thu, 6 Jul 2006 13:21:48

-0700

<Rheumatoid Arthritis >

Subject:

RE: Disagree with answers given

From Arthritis Foundation

at http://www.arthritis.org/conditions/DrugGuide/types.asp

" Biologic Response Modifiers <http://www.arthritis.org/conditions/DrugGuide/about_brms.asp>

Biologic agents were once reserved for people who's rheumatoid

arthritis symptoms failed to respond to other therapies. Now these agents are

benefiting more people in ways that weren't originally anticipated.

" DMARDs <http://www.arthritis.org/conditions/DrugGuide/about_dmards.asp>

Disease-modifying antirheumatic drugs (DMARDs) may actually

modify the course of inflammatory conditions, slowing or perhaps even stopping

their progression. "

The way I read this it agrees with Sierra by quoting the group

cited by Deborah. In my opinion biologics are just a special (and

expensive) class of DMARDs. It took a biologic for me to control my RA

but others get control with the older DMARDs because we are all different.

From: Rheumatoid Arthritis

[mailto:Rheumatoid Arthritis ]

On Behalf Of Deborah Bargad

Sent: Thursday, July

06, 2006 12:59 PM

Rheumatoid Arthritis

Subject: Re:

Disagree with answers given

The arthritis foundation lists MTX as a modifier only. This

is why it is called a DMARD. Check www.arthritisfoundation.org

<http://www.arthritisfoundation.org>

for more information. Hugs, Deborah

On 7/6/06, snowdrift52003

<

snowdrift52003@...> wrote:

>

> Dear Kathy- Remember that MTX modifies the disease but does

not halt

the progression of the disease... A biologic should be started to

ease

your symptoms and stop the progression.

MTX can indeed halt progression. Biolgoic meds can be very

hepful, but

they also carry significant risks. Only a rheumatologist can

effetively

assess the risk/benefit ratio for the individual.

-Sierra

[Guest guest]

Harold,

I completely agree with you. See my second post; I don't think I was clear at all in the first one.

----- Original Message -----

From: Harold Van Tuyl

Rheumatoid Arthritis

Sent: Friday, July 07, 2006 1:18 PM

Subject: RE: Disagree with answers given

..

[Guest guest]

I agree, because my first rheumy was not aggressive enough i now have joint damage!gwenorel@... wrote: you havea lot of chutzpah lecturing people about the downsides of medicine from the standpoint of someone with as you describe "no permanaent damage"! I've had to have all my mcp joints replaced due to damage and I was going to be a violinistwhen I was growing up physicians took the "conservative" approach... I have had this disease since age 14 and am now 41. I have had a LOT of time to weight the pros and cons and have been on every med

out there... Including plaquenil which did not halt progres for me. I wish there had been biologics 20 years ago. Forgive me but your disease is just not as virulent as others here and by counseling a "conservative" approach you could be doing a LOT of harm. For most people "waiting for a flare to pass on its own" WILL lead to irreperable joint damage. I wish you could see my x rays or give me back my music career. You mean well but you are not a physician and by throwing around scare tactics aboutmeds and suggesting the cure is worse than the illness you are irresponsible. Andi also have certainly experienced loads of side effects. My point is that for most of us RA is a VERY serious illness and finding the right med or meds is a priority not a step on the road to addi!ction. Please don't judge those of us who need that "cocktail" or imply that WE and not our physicians created it.Gwen(methotrexate, prednisone, biologic, azulfidine)Sent from my

treo-----Original Message-----From: "LH" <saludoFUSE (DOT) NET>Subj: Re: Disagree with answers givenDate: Fri Jul 7, 2006 10:03 amSize: 4K<Rheumatoid Arthritis >I see a Rheumatologist who is in a group practice with three other Rheumatologists, and there are seven or eight more in the immediate area. Obviously, there is a good selection, even within the practice I use. It's well-established and has been in existence for quite some time. My doctor is conservative when it comes to medications, but aggressive in treating early RA. I had an appointment yesterday and we discussed my meds(plaquenil) and either decreasing it to see if it really is effective, or changing to another med. I decided to do a decrease first. My RA appears to follow the pattern of severe

swelling/pain, lasting for well over a year in specific joints, and then "burning out," with little deformity and joint damage. As he said, he can't predict what will happen with each joint, but this appears to have been a consistent pattern over the last fifteen years. I'm having a lot of trouble with my hands now and we're giving it another six months to see if the same thing!happens. Hopefully, it will.Now, my point<g>. Several of you answer most posts from newer people and "recommend" a huge drug cocktail consisting of mostly biologics. Every single one of these medications, as well as the traditional dmards, has side-effects, and some of them are life-threatening. I'm not saying that we shouldn't be using them, but I do think that we need to balance our pain/discomfort with the potential side-effect of any medication we take. There is also the possibility that inflammation may recede on its own, or with naproxin/prednisone combination. There's been

some research showing that a steroid injection in one finger will sometimes alleviate swelling in the other fingers on the same hand, and there's also some indication that it has more of an effect in "stopping" the disease process than previously thought. The injections in specific small joints like that also do not have the bone-thinning effect that they do when given as a general infection or pill form. And yes, they HURT!, but only for a moment. Anyway, meds are a serious thing, and anything you put into your body is going to have an effect. As a side note: I just spent the last year with my best friend, who died recently in hospice(appendoceal cancer). She was totally addicted to oxycodone and dilaudid, and even though it was prescribed for pain, the addiction was there and was a factor that greatly affected what little quality of life she had left. Being in pain has little or nothing to do with developing an addiction to painkillers. It happens, and

denying it or ignoring obvious symtoms and rationalizing are all part of the addiction. These are not things to be taken lightly, and once addicted, you quickly build up a drug tolerance again when resuming the medication after a hiatus. Addiction medicine is a whole field in itself, and doctors who tell you that you cannot become addicted if you have "real pain" know little or nothing about addiction. It has nothing to do with how much pain you have, but instead, wi!th how much medication you take and for how long. Physical addiction progresses very quickly to psychological addiction, and that's where you completely lose perspective. That's why we have pain clinics -- continuous narcotics for pain are never the answer unless you are terminal. You cannot maintain for years on the same dosage of a narcotic and get the same pain relief. Eventually you will get to the point where your body tolerates and has adjusted to the highest dosage possible, and still have pain.

These drugs are never an "answer," but rather a bridge to a more permanent form of pain control. ----- Original Message ----- From: Deborah Bargad Rheumatoid Arthritis Sent: Friday, July 07, 2006 3:57 AMSubject: Re: Disagree with answers givenThe drug "May" help doesnt not mean it "Will" help. This article provides more details. Some people do find relief with MTX alone but this is not a vast majority. Hugs, Deborah http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=11409154 & dopt=AbstractOn 7/6/06, Gwen Orel <gwenorelcomcast (DOT) net> wrote:

Actually, people do use both. One of the things about the biologics is that at least with the case on enbrel they work better when combined with methotrexate. I take the dmard sulfasalazine, as well as methotrexate and enbrel (switching to orencia for insurance reasons).It isn't quite correct to look at biologics as just a newer kind of dmards. They work differently than the older dmards do. --- message truncated ---

How low will we go? Check out Messenger’s low PC-to-Phone call rates.

[Guest guest]

Dear - Amen. I have been undermedicating myself since my disease started. Why? If realized early on steriod has a severe effect on me metabolically. I have ever been on Ibuprofen for pain. I have used the same cocktail for a decade plus. My Rd told me to get my PCP to write most of my scripts. I tell her I take a half a pill of this and a nibble of darvocet at night. She prescribes me exactly that. Its so funny. Most doctors will take you figuratively but mine takes me literally. I get six pills to last me a month. I need to take an exta milligram of prednisone here and an extra ibuprofen there, because she doesnt understand maintenance medications and the good day/ bad day thing. Still, I live on the edge of pain all the time. Why? If I cant feel myself, I will overdo and hurt myself. My girlfriend has always had an unhealthy reliance on percocet etc. She is on a Phentenyl patch and was sent to a pain clinic and given methodone because she became addicted. That will NEVER happen to me. I rely on my Remicade to give me the most help and shore my flares up with steady low doses of my core meds which are prednisone, plaquenil and Ibuprofen. The day may come when god forbid I need extra. But I will get it because I undermedicate myself now and its on record. These days every doctor is scrutinized when dxing narcotics but I dont have that problem. Oh, and one more thing. I dont like feeling fuzzy or drugged up. It affects my quality of life and while some people dont mind that, I do. You have a good attitude. Hugs, Deborah

On 7/7/06, LH <saludo@...> wrote:

I see a Rheumatologist who is in a group practice with three other Rheumatologists, and there are seven or eight more in the immediate area. Obviously, there is a good selection, even within the practice I use. It's well-established and has been in existence for quite some time. My doctor is conservative when it comes to medications, but aggressive in treating early RA. I had an appointment yesterday and we discussed my meds(plaquenil) and either decreasing it to see if it really is effective, or changing to another med. I decided to do a decrease first. My RA appears to follow the pattern of severe swelling/pain, lasting for well over a year in specific joints, and then " burning out, " with little deformity and joint damage. As he said, he can't predict what will happen with each joint, but this appears to have been a consistent pattern over the last fifteen years. I'm having a lot of trouble with my hands now and we're giving it another six months to see if the same thing happens. Hopefully, it will.

Now, my point<g>. Several of you answer most posts from newer people and " recommend " a huge drug cocktail consisting of mostly biologics. Every single one of these medications, as well as the traditional dmards, has side-effects, and some of them are life-threatening. I'm not saying that we shouldn't be using them, but I do think that we need to balance our pain/discomfort with the potential side-effect of any medication we take. There is also the possibility that inflammation may recede on its own, or with naproxin/prednisone combination. There's been some research showing that a steroid injection in one finger will sometimes alleviate swelling in the other fingers on the same hand, and there's also some indication that it has more of an effect in " stopping " the disease process than previously thought. The injections in specific small joints like that also do not have the bone-thinning effect that they do when given as a general infection or pill form. And yes, they HURT, but only for a moment.

Anyway, meds are a serious thing, and anything you put into your body is going to have an effect. As a side note: I just spent the last year with my best friend, who died recently in hospice(appendoceal cancer). She was totally addicted to oxycodone and dilaudid, and even though it was prescribed for pain, the addiction was there and was a factor that greatly affected what little quality of life she had left. Being in pain has little or nothing to do with developing an addiction to painkillers. It happens, and denying it or ignoring obvious symtoms and rationalizing are all part of the addiction. These are not things to be taken lightly, and once addicted, you quickly build up a drug tolerance again when resuming the medication after a hiatus. Addiction medicine is a whole field in itself, and doctors who tell you that you cannot become addicted if you have " real pain " know little or nothing about addiction. It has nothing to do with how much pain you have, but instead, with how much medication you take and for how long. Physical addiction progresses very quickly to psychological addiction, and that's where you completely lose perspective. That's why we have pain clinics -- continuous narcotics for pain are never the answer unless you are terminal. You cannot maintain for years on the same dosage of a narcotic and get the same pain relief. Eventually you will get to the point where your body tolerates and has adjusted to the highest dosage possible, and still have pain. These drugs are never an " answer, " but rather a bridge to a more permanent form of pain control.

----- Original Message -----

From: Deborah Bargad

Rheumatoid Arthritis

Sent: Friday, July 07, 2006 3:57 AM

Subject: Re: Disagree with answers given

The drug " May " help doesnt not mean it " Will " help. This article provides more details. Some people do find relief with MTX alone but this is not a vast majority. Hugs, Deborah

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=11409154 & dopt=Abstract

On 7/6/06, Gwen Orel <gwenorel@...

> wrote:

Actually, people do use both. One of the things about the biologics is that at least with the case on enbrel they work better when combined with methotrexate. I take the dmard sulfasalazine, as well as methotrexate and enbrel (switching to orencia for insurance reasons).It isn't quite correct to look at biologics as just a newer kind of dmards. They work differently than the older dmards do.

From: Harold Van Tuyl <hvantuyl@...>Reply- "

Rheumatoid Arthritis " <Rheumatoid Arthritis >

Date: Thu, 6 Jul 2006 13:21:48 -0700

<Rheumatoid Arthritis >

Subject: RE: Disagree with answers given

From Arthritis Foundation at http://www.arthritis.org/conditions/DrugGuide/types.asp

" Biologic Response Modifiers

<http://www.arthritis.org/conditions/DrugGuide/about_brms.asp>

Biologic agents were once reserved for people who's rheumatoid arthritis symptoms failed to respond to other therapies. Now these agents are benefiting more people in ways that weren't originally anticipated.

" DMARDs

<http://www.arthritis.org/conditions/DrugGuide/about_dmards.asp>

Disease-modifying antirheumatic drugs (DMARDs) may actually modify the course of inflammatory conditions, slowing or perhaps even stopping their progression. " The way I read this it agrees with Sierra by quoting the group cited by Deborah. In my opinion biologics are just a special (and expensive) class of DMARDs. It took a biologic for me to control my RA but others get control with the older DMARDs because we are all different.

From: Rheumatoid Arthritis

[mailto:Rheumatoid Arthritis ] On Behalf Of Deborah Bargad

Sent: Thursday, July 06, 2006 12:59 PMRheumatoid Arthritis

Subject: Re: Disagree with answers given

The arthritis foundation lists MTX as a modifier only. This is why it is called a DMARD. Check www.arthritisfoundation.org

<http://www.arthritisfoundation.org> for more information. Hugs, Deborah

On 7/6/06, snowdrift52003 <

snowdrift52003@...> wrote:

>> Dear Kathy- Remember that MTX modifies the disease but does not halt the progression of the disease... A biologic should be started to ease your symptoms and stop the progression. MTX can indeed halt progression. Biolgoic meds can be very hepful, but they also carry significant risks. Only a rheumatologist can effetively assess the risk/benefit ratio for the individual.-Sierra

[Guest guest]

Well I went from 99 to 2004 before being DXed then got the cocktell a little over a year and the pain was still very high before I had to give it back up and now it's allmost unbearable . When people sitting around thinking lifes no good like this I don't think there's a lot of Drs that would disagree it's time to try something . johngwenorel@... wrote: you havea lot of chutzpah lecturing people about the downsides of medicine from the standpoint of someone with as you describe "no permanaent damage"! I've had to have all my mcp joints replaced due to damage and I was going to be a violinist when I was growing up physicians took the "conservative" approach... I have had this disease since age 14 and am now 41. I have had a LOT of time to weight the pros and cons and have been on every med out there... Including plaquenil which did not halt progres for me. I wish there had been biologics 20 years ago. Forgive me but your disease is just not as virulent as others here and

by counseling a "conservative" approach you could be doing a LOT of harm. For most people "waiting for a flare to pass on its own" WILL lead to irreperable joint damage. I wish you could see my x rays or give me back my music career. You mean well but you are not a physician and by throwing around scare tactics aboutmeds and suggesting the cure is worse than the illness you are irresponsible. Andi also have certainly experienced loads of side effects. My point is that for most of us RA is a VERY serious illness and finding the right med or meds is a priority not a step on the road to addi! ction. Please don't judge those of us who need that "cocktail" or imply that WE and not our physicians created it. Gwen (methotrexate, prednisone, biologic, azulfidine) Sent from my treo -----Original Message----- From: "LH" <saludoFUSE (DOT) NET> Subj: Re:

Disagree with answers given Date: Fri Jul 7, 2006 10:03 am Size: 4K <Rheumatoid Arthritis > I see a Rheumatologist who is in a group practice with three other Rheumatologists, and there are seven or eight more in the immediate area. Obviously, there is a good selection, even within the practice I use. It's well-established and has been in existence for quite some time. My doctor is conservative when it comes to medications, but aggressive in treating early RA. I had an appointment yesterday and we discussed my meds(plaquenil) and either decreasing it to see if it really is effective, or changing to another med. I decided to do a decrease first. My RA appears to follow the pattern of severe swelling/pain, lasting for well over a year in specific joints, and then "burning out," with little deformity and joint damage. As he said, he can't predict what will

happen with each joint, but this appears to have been a consistent pattern over the last fifteen years. I'm having a lot of trouble with my hands now and we're giving it another six months to see if the same thing! happens. Hopefully, it will. Now, my point<g>. Several of you answer most posts from newer people and "recommend" a huge drug cocktail consisting of mostly biologics. Every single one of these medications, as well as the traditional dmards, has side-effects, and some of them are life-threatening. I'm not saying that we shouldn't be using them, but I do think that we need to balance our pain/discomfort with the potential side-effect of any medication we take. There is also the possibility that inflammation may recede on its own, or with naproxin/prednisone combination. There's been some research showing that a steroid injection in one finger will sometimes alleviate swelling in the other fingers on the same hand, and there's also some

indication that it has more of an effect in "stopping" the disease process than previously thought. The injections in specific small joints like that also do not have the bone-thinning effect that they do when given as a general infection or pill form. And yes, they HURT! , but only for a moment. Anyway, meds are a serious thing, and anything you put into your body is going to have an effect. As a side note: I just spent the last year with my best friend, who died recently in hospice(appendoceal cancer). She was totally addicted to oxycodone and dilaudid, and even though it was prescribed for pain, the addiction was there and was a factor that greatly affected what little quality of life she had left. Being in pain has little or nothing to do with developing an addiction to painkillers. It happens, and denying it or ignoring obvious symtoms and rationalizing are all part of the addiction. These are not things to be taken lightly, and once addicted, you

quickly build up a drug tolerance again when resuming the medication after a hiatus. Addiction medicine is a whole field in itself, and doctors who tell you that you cannot become addicted if you have "real pain" know little or nothing about addiction. It has nothing to do with how much pain you have, but instead, wi! th how much medication you take and for how long. Physical addiction progresses very quickly to psychological addiction, and that's where you completely lose perspective. That's why we have pain clinics -- continuous narcotics for pain are never the answer unless you are terminal. You cannot maintain for years on the same dosage of a narcotic and get the same pain relief. Eventually you will get to the point where your body tolerates and has adjusted to the highest dosage possible, and still have pain. These drugs are never an "answer," but rather a bridge to a more permanent form of pain control. ----- Original Message -----

From: Deborah Bargad Rheumatoid Arthritis Sent: Friday, July 07, 2006 3:57 AM Subject: Re: Disagree with answers given The drug "May" help doesnt not mean it "Will" help. This article provides more details. Some people do find relief with MTX alone but this is not a vast majority. Hugs, Deborah http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=11409154 & dopt=Abstract On 7/6/06, Gwen Orel <gwenorelcomcast (DOT) net> wrote: Actually, people do use both. One of the things about the biologics is that at least with the case on enbrel they work better

when combined with methotrexate. I take the dmard sulfasalazine, as well as methotrexate and enbrel (switching to orencia for insurance reasons). It isn't quite correct to look at biologics as just a newer kind of dmards. They work differently than the older dmards do. --- message truncated ---

Want to be your own boss? Learn how on Small Business.

[Guest guest]

I, for one, am glad that I got RA in a time when biologics were available to me.

I was given Enbrel as soon as I was diagnosed as I had had the condition

already for 6 months. I am now in good control with Humira, the difference is

night and day! I do not have any permanent joint damage. I know there is a

danger of Lymphoma but I was on my way to being crippled before the

biologics.

Who says MTX and others don't have potential side effects? I am pregnant

and biologics are safer to take in pregnancy, classified as Category B, where

MTX is classified as Category X, meaning it definitely will cause birth defects.

> Actually, people do use both. One of the things about the biologics is that

at least with the case on enbrel they work better when combined with

methotrexate.

>

> I take the dmard sulfasalazine, as well as methotrexate and enbrel

(switching to orencia for insurance reasons).

>

> It isn't quite correct to look at biologics as just a newer kind of dmards.

They

work differently than the older dmards do.

>

> --- message truncated ---

>