V, I'm so sorry you're not sleeping.  It seems like one of the fastest ways to a flare is a crummy night's sleep for me.     The amazing Dr. L was absolutely great, as always.  He said, "Of course it's all extremely individual.  Every patient has a different response to time, therapy and medication.  My goal for you is always going to be remission.  I won't ever stop trying to get you to the point that you barely know you have this disease.  We're still early in the game, too.  There are lots of meds we can try, and something WILL help.  Yes, I've seen people who never get relief, but those are the exceptions to the rule, and I'm still trying to find ways to help them.  If you don't give up, I won't."     Basically, it was a very kind and responsive, "Who knows?" but he listened to everything I said, answered my questions, and didn't treat me like an idiot.  He also didn't say it as if he's not had to say that 1,000 times a day for at least 10 years, but he's probably raking in $300,000 a year.  If I made that kind of money it might not get old for me either!  .     He's now doubled my Enbrel to 50mg twice a week for the next three weeks because I'm definitely responding, just not ENOUGH.  If I haven't achieved a much better state by then, we'll move onward to Humira.  If that doesn't work pretty swiftly, he'll try another type of biologic other than a TNF-blocker.