A new RA patient and worried

[Skubakat]

I have recently been diagnosed with RA.  I am 41.  I walk in to the MDs office and after 15 minutes he wants to start me on MTX. My history is joint pain, platlet clumper, total hysterectomy, weight gain, childbirth, and other than parents expired from types of cancer (AML (age 44) and Colon and liver CA (age 60))  at a young age I am a healthy person.   My question is my xrays so far are normal blood work was told normal other than liver panel a little high.  MTX affects the liver and lungs.  He told me I should think about quality of life.  My concern is liver and my recent loss of a parent due to liver cancer and the fact what MTX does to the liver.  I have to make a decision on what to do.  Is there a better alternative to what I can do or ask for.

[txsilver]

Great advice from Perkins!  I was started on plaquenil.  It is a milder drug and, after I took MTX for 6 months then quit, is controlling my RA symptoms.  All drugs have side effects so you do have to consider all the ways the disease effects your life and the risk/benefit of the medication.  From my experience, it is better to start with the lower level drugs and work up from there until you get relief.  
If you want to try plaquenil or something else prior to taking MTX and your rheumy does not understand or agree to treat you, see another doctor.  Keep changing doctors until you find one who listens to you, is interested in your case and will partner with you in your treatment.   Chronic conditions such as RA require that we have the best possible relationship with our doctors.  You deserve that.  Please let us know what you decide to do, what you end up taking and we will help you through this.

[perkins2505]

Sorry to hear about your diagnosis. The good news is that there are lots of treatments and more on the way.

I would be worried about getting MTX rx after just 15 minutes. My first rheumatologist visit was over an hour, and we went over many options. I did start with MTX. It's cheap and sometimes very effective. It does irritate the liver a bit. Your liver panel (usually AST and ALT) shows just how irritated your liver is, and it sounds like yours is already a little high. You'll probably be asked to do regular blood tests while you're on MTX, and you should do them!

If you read more about MTX and don't want to try it, there are many other choices. You need to find a doctor that will talk about them with you. It can't be done in 15 minutes. You should also bring information about your insurance coverage. Some of the new medications are very expensive (like $2000 per month) so your coverage matters.

You've probably had your symptoms for a while, so take your time and make an informed decision. But keep in mind that if the first thing doesn't work out, there're are lots of choices.