Well... all of this seems to be opinion. By "all of this" I mean the world of Rheumatology. I'm guessing this is his preference and opinion.

Some thoughts...

I found it noteworthy that my PCP was afraid of Methotrexate. It's the only time I'm ever seen him get nervous in a conversation.

Plaquenil was the first DMARD offered to me because my RA is not really aggressive.

I have been on Plaquenil for a little over a week, and I swear my pain has diminished noticeably. For what it's worth, I am seronegative.

So, give it a go. It might work.

It makes me wonder if perhaps he or a colleague of his was involved in a lawsuit over MTX and pregnancy. Or maybe he's just plain terrified of a patient losing a pregnancy because of MTX he prescribed.

I was past the child-bearing years by the time I started on these drugs, so no personal experience here. Several folks have done well on plaquenil, though. Don't feel like you're getting third-rate treatment. There are lots of choices, and lots of combinations.

Plaquenil carries the same pregnancy warnings as MTX. I just started Plaquenil this week so I've been reading up on all the effects (in addition to the MTX I've been doing for several months).

Yes, but I don't think it puts the same "baby deforming" fear into physicians from all specialties. Quote is from my PCP.

My doctor started me with plaquenill and then added mtx later when the plaquenil wasn't enough to remove my pain and swelling. I think they always want to try the lowest dose, mildest drugs first.

Are you in a position to become pregnant and/or planning to become pregnant? If so, best to avoid the mtx. Also, they say that in pregnancy all pain goes away.

I was told the same thing by my doctor, rheumy. She didn't put me on MTX at first because I wasn't sure of the baby thing. (I have fertility issues as well...unsuccessful IVF last year) I decided to not pursue having a baby any further and she decided to let me try MTX. If you saw my previous discussion post, 4/30, I had some bad effects from the MTX. Doctor ultimately wants me on a biologic, like Humira, but I tested positive on my Bracanalysis (breast cancer gene). This haulted that discussion for a month as biologics increase risk of cancer (according to my rheumy). I am now having to see a genetic counselor and possibly more genetic testing. Wonderful...anywho...if you are considering having a baby, I would stay away from MTX. Good luck on deciding what to do...I am still trying to find the right medication combination for me as I was only diagnosed officially in February.

I didn't react well to MTX so in January they started me on Plaquenil. It's May now and I am starting to see some improvement. My dr did a Vectra test to see what's going on because it's been really rough. But I do have faith in the Plaquenil. Some show relief sooner than others but my doctor said to give it 4-5 months to see huge benefit which seemed like FOREVER at the time. But just take it a day at a time...I wish you the very, very best and I hope u have a restful night. I know that must be stressful to be of child bearing age and have to handle those issues also. I'm past that at age 51 and have had hysterectomy.

When my older brother was first diagnosed he used Plaquenil. He now is well controlled with Arava. He's never used methotrexate because then I could not have his occasional beer. Fortunately he hasn't needed it either.

Interesting conversation since one of my friends who recently discovered that she's a lucky one like me - tried diet BECAUSE her rheumy was pushing MTX & biologics. She's only 23 and those meds scare her at this point.

Have another friend that's doing very well on just plaquenel. She only has a few fingers giving her grief, so is a pretty mild case at this point.

Each rheumy's philosophy is different I guess. Mine also tried to pressure me onto mtx as his first choice treatment.

i was dx'd at 33 (seronegative) and started immediately on mtx. when i later asked my rheumy why we didn't try plaquenil, etc. she said that my disease was very active and appeared very aggressive. she said that mtx was the last dmard of those pills that she usually prescribed; if my case was not as aggressive, she would have started with another drug like plaquenil or sulfasalazine. my baby maker has been rendered ineffective so pregnancy isn't an issue for me.

Thanks for the responses. I do not plan on having any more kids and I take my pill everyday. I guess there is a 1% chance of pregnancy that he is not comfortable with.
I go back in a month to get blood work and see how the plaquenil is working. He said he will give it three months and if he doesn't see an improvement then he may add a biologic. My RA is mild so I'm a little nervous about the biologic.

the OB / GYN gave me methotrexate for two ectopic / tubal pregnancies, about 2 years apart, each time more and more of the MTX opting to do that instead of surgery on the tubes. worked both times, so slowly.

if you are done with kids, you've done your part, have your husband talk to HIS doctor..., :) and then maybe the Rheumie might change his tune...

if you are not sure, stay good and off MTX

depot

Thanks for the info RASally!

I was my RF was positive at around 300 and my ccp was >250. I'm not sure what that all means yet but I am trying to figure it out.

Thanks RASally. That article is wonderful. It really helped explain my doctor's rationale for the drug choice. Since he won't prescribe any other DMARDs, it looks like the biologic is the next step and the article states that too.

With my lab work, I also got a 'Vectra Disease Activity Test' where they review all my blood work and determine the activity level. That came back high so even though I only have minor aches and pains, it looks like this needs to be treated aggressively.

I really appreciate all of the support and helping me make sense of everything.

I was diagnosed at the age of 26 with moderate-severe symptoms. I was immediately started on methotrexate. The effects on the child if I were to get pregnant were explained to me, and it was also explained that you have to stop taking methotrexate for at least 3 months before attempting to become pregnant. I have always used condoms as a contraceptive and recently started using an oral contraceptive because of the menstrual irregularities caused by the mtx.

Any woman of child-bearing age can get pregnant despite the use of contraceptives, yet as far as I can tell, most doctors don't use that as an excuse to withhold a medication that can be extremely effective for the treatment of this progressive disease, and when the patient can effect preventative measures. I think that the decision to use a certain medication should be collaborative, with both your doctor AND you having input. If you are not planning to become pregnant and you agree to use an extra method of contraception, then why shouldn't you be "allowed" to use mtx? Unless the concern is that you are already pregnant (and could they not test for that at the appropriate interval from last intercourse)? My second rheumatologist and I have discussed the need to carefully plan any future pregnancy, because various meds may need to be discontinued, and other meds may be added to manage symptoms so I can have as comfortable a pregnancy as possible (not all women go into remission during pregnancy, though many do).

If you are comfortable with his proposed treatment plan, then I hope it works well for you and you experience relief soon. It is just my opinion that all options should be open as much as possible, especially in a case like this where it is your behavior and family planning that are a factor, and not something like an allergic reaction or intolerance.