<p>I have had rheumatoid arthritis for 23 years, and I would say that it is under very good control. I have cycled through many drugs, but have never used a biologic or Type 2 collagen. I began with Plaquinil, moved on to Azulfidine, and then onto Azulfidine and Diclofenac together. After an unusually severe flare up, I was prescribed Methotrexate, but the side effects were a problem, and it didn’t work for me. My rheumatologist took me off Diclofenac after a study showed a greatly increased risk of heart disease with its use. I now take Azulfidine and Celebrex together, which seems to be working.</p>
<p>I am giving you this history, because I want to make the point that different drugs may work for you at different times. Some may work; some may never work; some may work for awhile and then lose their efficacy–and you won’t know the result until you try them. There is usually a hierarchy for trying new RA drugs which seems to be based on their strength, their potential side effects, and the willingness of insurance companies to cover them. For instance, in my experience most insurance companies will require you to “fail” on Methotrexate before being willing to cover a biologic. In my own case, I was taking Celebrex for over a year, when suddenly my insurance company wanted me to switch to Naproxen to reduce their cost. I had to spend 6 miserable weeks on Naproxen, before my rheumatologist could convince them to cover the Celebrex again.</p>
<p>I have no idea why your rheumatologist has chosen to treat you with the particular drug you are currently taking, or why he (or she) is recommending a combination of Methotrexate and a biologic, but if you are uncomfortable with taking the Methotrexate, it would be perfectly reasonable to ask your rheumatologist about the possibility of starting with an NSAID or Celebrex along with your Plaquinil. You could also ask about Azulfudine as a substitute for the Plaquinil. Finally, it might be prudent to ask your insurance company what drugs they will cover and when. </p>
<p>In any event, I wish you well and sympathize with the pain you must be feeling during this flare up.</p>