Both, together. Neither did much for me without the other.

Both, for sure! I can't take Humira because it affects the liver too much. But I would go for the biologic if you can only take one or the other!

What if you're allergic to either one? You probably can't know unless you try, but it's a real possibility, I'm sorry to say. In the spirit of how I understand your question, I'd say try MTX alone first. It may work well for you by itself.

I was required by my insurance company to go with methotrexate first, although that is also what my Rheumy wanted to do. It was not effective for me alone, so they added plaquinil and sulfasalazine. Eventually took me off of MTX, and added luflidimide. Added Humira in November and this cocktail seems to be working better. However, last appointment I was not where the doctor wants me, so I will have scans/ultrasounds in June and we shall see. What I have learned over the past 3 years is there is no one or the other, and every person is different.

are you being treated by a primary care that is asking you which you want?

A rheumatologist asked you this question?

have you read up on your disease? all the dmards, all the biologics? read through your group insurance policy? talked to your rheumatologist about her usual and customary course of treatment? spoke to the insurance liasion in the office who knows a lot about pre-admission authorization for treament (the biologics can cost thousands per week - the dmards have been out 40 years and are cheaper)?

Grab a catch all book on RA from amazon or library.

it depends, on you, your diagnosis, your group health or individual health insurance policy, your rheumatologist's recommendation, your pharmaceutical coverage according to the terms of your policy, your co-illnesses, you. sometimes it also depends on the family budget: deductibles, co-pays, and budget. as Joline pointed out allergies are also another factor. I started out bravely on my first dmard and was allergic to it and changed tack onto another dmard that I was not allergic to. see if you can start reading so you can keep pace with your MD in terms of familiarity and brilliance. Get familiar first with RA dmards (disease modifying anti rheumatic drugs) and maybe the names of the diagnostic bloodwork they did on you. It's a bummer all this extra thought and work. you'll get there.

depot

All of you are SO informed on RA. Thank you so much for the responses. My Rheumatologist gave me the choice on which way to go and I am thinking Methotrexate first. If I tolerate that well but still need more she could add Humira. She is prescribing some type of folate pill to go with the methotrexate too.

If I was given the choice I would take Humira and not ADD methotrexate unless it was necessary. The reason is because I personally feel that methotrexate did more damage to my immune system, putting me at risk for infections, that the biologics.

You need to read and educate yourself in order to make an informed choice along with your rheumatologist. Read how these drugs work and the side effects.

A lot of good information has been mentioned about issues surrounding this decision - allergies to meds, other medical conditions or medications you are taking, insurance issues.

Some of the decision also depends on your rheumatologist -- is he/she an older clinician with a lot of patient experience, or someone newer to the field? Then there are the clinical practice guidelines -- which tend to be followed more closely by newer physicians who are depending on the expertise of "seasoned" rheumatologists and any available research. The guidelines (in the US at least) recommend in early RA, in a patient never treated with DMARDS, to start with DMARD (MTX) if there is not a contraindication. If there is not a good response, then the next step is adding a biologic. Oral steroids also play a role in there too, but your question was mainly about these two meds.

Your rheum may be giving you a choice....which not all physicians will do...but the most important thing is to ask
1. When should I expect some improvement?
2. What are you going to do if I do not see that improvement?

For the record...I started on MTX along with relatively low dose prednisone. Humira was added approx 4-5 months later due to progression of symptoms (in my case more joints joining the party, though still mild with respect to amount of pain).