Lene, Thanks for your thoughtful reply. I guess that what you are saying may be true. The MTX has reduced my symptoms from flame to smoldering but not exactly gone. Where on a daily basis I had all the joints in my hands and feet and my shoulders and knees and ankles and wrists just miserable now most of them are just stiff and a little painful and a few are still very annoying. I have been able to become a little more active but am still terribly fatigued and any kind of extra physical activity seems to set off more pain. I would very much like to be more active but not at that price! I need to call my Dr. early next week since my liver numbers are up anyway so maybe we can discuss this then. Thanks so much!

I've been on the methotrexate for just about a year now with increasing doses at each appointment. At my last appointment he put me on the max dose of 20mg - I had to split it to tolerate it and am still having some side effects - but he said we should try this first but I should be considering a biologic. I believe at this point I am convinced it is time to give that a try. Although I understand that they do work better if you continue to take the MTX and maybe an injectable would relieve the side effects and increase effectiveness for me. Or perhaps I could go back to a slightly lower dose with a more effective drug added like a biologic.

i agree there is active diease in the ankle.  Can say been there done that.  I now have a fused ankle.  Was onmetrotrexate pills for a while, to many side effects. 

was put on methrotrxate shots, did good for about 18 months.  Tehn side effects hit again hard.  Got to where in was sick in bed 2to 3 days after my shot and i had shots weekly. Told my dr i was done with metrotrexate no matter what she said, it just wasn't worth it.  I went on enbrel and plaquenil and that was 9 years ago and i love it.  I've had a foot ankle fusion, one total elbow replacement and needing other elbow replaced.  But this from early damage.

Just wanted to update you. I talked to my rhuemy and my liver numers are stable. He's not happy with the number and frequency of flares (me neither - lol!) and ordered a vitamin d and thyroid test in case this might be contributing to my fatigue - these were okay when checked before but that was a couple a years ago and he didn't have those tests. He offered a prednisone taper to help with the ankle but since the rest of my joints are doing fairly well and I am managing ok with wrapping it, ice and rest, I decided not to do that for now. It actually seems to be settling down some. If it gets worse, I can reconsider. We've decided it's time to add a biologic and have started the preapproval process for humira. I'm going to get a shingles vaccine first since I won't be able to get one later even though I am not yet 60, it seemed prudent since I'm close to that age and the biologics lower your immunity. So it will be a few weeks, but then we'll see. This is a big decision for me but I think it's the right one.