Like all the other RA meds, they all act differently with different people and seems to be a hit or a miss as all the other meds are. I think part of the reason it seems those on infusions speak highly of them because they are usually the very, very last option for a drug used to treat RA and we have failed all the others so to finally have something work, we sing it's praises. But they don't work for everyone.

I will also admit, infusions are usually the slowest of the slow to start working. My rheumatologist calls them barges because they can take 3 to 6 months or longer to work (it took 8 months for it to work for me) and once they are infused there is no stopping them (much like once you start a barge moving it's hard to stop it). So for instance your body can't suddenly start making the 'T' cells that say Rituxan kills off. It takes about a half year to get those back unlike the week to a month to recover from your last TNF blocker injection.

This can be critical if you get sick and need your immune system back. I know when I was on a TNF blocker and got pneumonia, skipping a couple of weeks of it was critical to my recovery, but you don't have that option with infused medications.

I think it's fairly common too that for insurance to cover them you have to fail various other treatments. For me I had to fail a slew of DMARDs and even had to fail at least two TNF blockers before I could try an infused med for insurance to cover it. So it might not even financially be an option for you unless the other options have been tried. I live in the US and have private insurance (I'm in my 40s and not on medicare), but the bill for a single Rituxan infusion without insurance was $54,000.

I also know of people who absolutely hate infusion and they basically messed up their life for a full year as they totally tanked their immune system and as I mentioned before you can't readily undue what those infusions do.

P.S. Also be prepared to spend a full day being infused. Rituxan, the quickest it can be infused is 6 hours and some odd minutes. Because I have a fairly severe reaction to it they have to infuse it slower and it takes 12 hours to get the full dose in me. The number of times you need to do this in a year varies from person to person.

In the end this is really a conversation you need to have with your rheumatologist and insurance.

Rituxan kills B cells. Orencia kills T cells. I've been on both.

As far as mthx is concerned, 6 weeks to 3 months to start working. So, you need to wait before giving up on mthx.

Further, as smith101 notes, you can't just snap your fingers and jump to infusions. Most insurance demands you fail at least 3 DMARDs, and also use them together. Then you will be eligible for injections. After you have tried injectable biologics, and they don't work, you can go to infusions. Some of them did not work well for me. Actemra was the worst. I had terrible side effects, and it didn't work.

I have used up all but 3 biologics, and my rheumatologist feels none of them will work for me.

Anyway, talk to your rheumatologist when you've been on mthx for 3 months. I failed mthx on its own, but combined with certain biologics, I was 100%. I'm still on mthx, with Cimzia. Cimzia is giving me hand deformities, but I don't know if anything else will be any better.

I hope mthx kicks in soon for you.

Sorry, I forgot about prednisone. It is good to bridge till real RA meds kick in. Short term use, not long term.. Read about the side effects of long term use of prednisone. I've had most of them. My cousin was on prednisone for 65 years, and it damaged her so much.

I have adrenal insufficiency now, every time I briefly go on prednisone. That means my adrenal gland struggles to make cortisol on its own. My cousin had no adrenal gland function at all. It works quickly to lower pain, but it doesn't stop the progression of the disease. So, if you rely on prednisone, you will end u with terrible deformities. It should not be an option to take long term!

MTX took 5 months to begin working. It was starting to help a lot, but then I developed what used to be called bronchiolitis with organizing pneumonia (BOOP), now called cryptogenic organizing pneumonia. Saved by massive steroids and antibiotic infusions and excellent percussive respiratory therapu.

Next up was Remicade, an anti-TNF infusion. That looked like it was going to be a winner, but I developed bone-marrow suppression, which manifested with a 103.5 fever and all my blood cell counts tanking.

Doc said no more anti-Tnf's, and I wasn't interested in other choices, so I went to Rituxan in April 2008. It took 3 months to start working, and I only got 2 lovely months, before another 3 months of nothing. But from December 17, 2008, it worked wonderfully, turned my life back around. I had always been very active before RA, and once I was taking Rituxan, it was only a matter of regaining strength before I was just as active as before.

I recently had to skip an infusion set so that I would have cancer procedures and treatment postponed, but I'm back taking Rituxan again, after 11 months. I think it's going to be a while for it to work again, if at all, but I'll give it a chance to work before I try prednisone again. I last tapered off that stuff just before I started Rituxan.

Rituxan protocols have changed since the old days for those who can tolerate them. My first infusions in NC took less than 2 hours, including 1/2 hour for pre-meds. I've cut back Benadryl to 12.5 ml, but think I'll drop it completely. I may ask to drop the 120 ml Solu-medrol, as well. For my last infusions, I actually asked to have the total time increased by 1/2 hour.

Good luck.

It's great to be part of community that understands. Thanks for your input.