Alternatives to Methotrexate?

I was on methotrexate (MTX) for more than 20 years (10 years on the tablets and 10 years on the injectable) and it served me well.  My doctor said I had to take a break from it in 2008 and just took me off it altogether with no replacement.  I suffered few side effects from the withdrawal of MTX and have been getting along fine with a few over-the-counter painkillers and tramadol ever since.  But now I'm getting fairly regular 'flares', and the effects of deterioration of my hand and foot joints, as well as my hips, are really starting to show.  I'm thinking I need to get back on serious RA meds again to arrest the disease.  Trouble is, I live in Mexico, and Mexican authorities have phased out MTX in all their pharmacies. I would have to have it trucked in to my town on the west coast from Mexico City, IF I could get a special prescription for it.  The cost, also, would be prohibitive.  Is there any other medication you would suggest which has worked for you? (20 years ago, I tried plaquenil and it wasn't nearly as effective as MTX). I am seeing my doctor tomorrow, but would appreciate suggestions so I can talk to him about them.

[S. Kaul, MD]

Hi there!

Other disease modifying medications that could be used are hydroxychloroquine, sulfasalazine, azathioprine, cyclosporine, d-penicillamine, gold salts, leflunomide, minocycline, cyclophosphamide etc. I would suggest discussing the options in detail with your treating rheumatologist
Hope this helps.

Take care!