ANSWER TO QUESTION REGARDING "OVERLAPPING ARTHRITIS"
From a reader: "I have an overlapping arthritis, based on my last x-rays, I have deterioration in all of the fingers on my left hand, as well as my knuckles and wrists on both hands. I also have deterioration in 3 fingers on my right hand. ...
I would like to know if you could advise me of any arthritis drugs that could maybe slow down the deterioration?
Answer: Deterioration could mean several things - including joint deformities or joint erosions.
An even more important question deals with whether you have active joint disease that would respond to even more aggressive therapy. Perhaps the damage is done, so to speak. If that is the case, no drug is going to reverse the deformities that have developed as a result of the unchecked inflammation of progressive rheumatoid arthritis.
You mention swelling, but you have no morning stiffness. Usually, patients with active inflammation will have significant morning stiffness - or sometimes all-day stiffness. Is your sedimentation rate or C-reactive protein elevated (which could indicate ongoing joint inflammation)?
Methotrexate is a strong disease modifying drug. It is referred to as a disease modifying drug because it has the potential to allow a patient to actually go into remission. Assuming you are having no adverse effects associated with it, the dose you are on is reasonable. The combination with Plaquenil probably does not add all that much.
However, if the methotrexate and Plaquenil do not offer complete control of your arthritis, then most rheumatologists in the United States would add a so-called biologic agent to your regimen. Generally, the first choice would be a tumor necrosis factor (TNF) inhibiting drug. The anti-TNF drugs now on the market in the United States include Enbrel, Remicade, and Humira. Orencia is also indicated for those rheumatoid arthritis patients who are not helped by methotrexate, but it works differently than the anti-TNF drugs.
In patients with moderate to severe disease, methotrexate often is used in combination with other disease-modifying drugs. In patients with active and severe disease, initial therapy often consists of a combination of medications. The combination of methotrexate, Plaquenil and sulfasalazine has been one of the more popular regimens, but as I discussed in the previous paragraph, nowadays the combination of methotrexate with a biologic agent has become the treatment of choice if methotrexate or a combination of methotrexate with another disease modifying drug is not offering ideal relief to the patient.
If the deterioration you refer to in your question involves tendon damage or crippling joint destruction, then orthopedic surgery has the potential to improve function, mobility, pain control, and quality of life for the rheumatoid arthritis patient.