MTX not working

Tomorrow I have an appt with my rheumatologist. Much as I would like to think that things might change, I'm not too certain. I started MTX 6 months ago, and while at my last visit my dr seemed to think that I was getting improvement, I disagree. The only "improvement" is that I am less nauseated by the MTX now. I still have swelling in multiple joints, and have added in more inflamed tendons to the ones that were already inflamed in my ankles.

I'm wondering if it's possible that the insistence on 6 months of MTX is due to insurance issues that I wasn't aware of. What do I do if the rheumy continues her argument that the MTX is "working"?

My response in a similar situation was quite blunt; you may believe that its working, but how I am now is not an acceptable situation for me, do something needs to change.

I’ll admit that I was quite assertive. I made it quite clear that I would have to quit my job, and described the myriad of other things that weren’t going to be sustainable in the long run, without doing a “poor me”

It’s one approach you could try. The rules are different here in Aus, so I didn’t get what you probably want, but I got what I needed.

Another piece of information that I found made it easier for me to be assertive was;

This is an Australian summary of the situation, but if you look around, you’ll find something similar for most rhuematology associations - that whilst most physicians interpret improvement with MTX, and ESRs may reduce, patients don’t often report much improvement, and it has no demonstrated impact on joint damage (in PsA).

I didn’t shove it down my rhuemys throat like I knew more than him, but it made me feel confident insisting on a biologic, even though he feels the risk outweighs the benefit (and that part, he’s actually not really qualified to comment on - because he’s never had it, so has a very limited understanding of the benefit side of the equation) .

Good luck - it’s worth keeping trying till you find something that works!