MTX, RTX or Cyclo?

[Yvonnea]

Hi Folks,
Just wondering if you could offer me some advice?
Am meeting with my Rhumie tomorrow to discuss recent flare in nose and sinus.
He wants me to decide between going back on cyclo (have been on it twice, once oral and one time IV) or maybe trying RTX or Mtx. The cyclo worked when flare was in lungs (well for a time) it got me into remission and I was able to switch to imuran.
Worried about lasting damage to fertility with cyclo, and have heard good things about RTX but so unsure what to do.
Any help greatly appreciated.
Thanks.

[Jack]

If it worked last time and you were not taking it for too long I think I would stick with Cyclophosphamide. It is not as if alternatives are risk free. If your case is similar to mine, the ctx treatment for flare ups did not need to last for very long before things were back under control, but you have to act fast.

[jola57]

I'm with Jack, both ny flares were controlled successfuly by cyclo.

[Sangye]

Involvement that's limited to the nose and sinuses doesn't generally warrant ctx. It makes more sense to try a milder drug like mtx first. Especially since you've already used ctx twice and you have a history of lung involvement-- seems like it's best to save your remaining lifetime amount of ctx for a time when you might really need it.

[drz]

I think it depends upon the severity of the flare and how you respond to various drugs. My last nasal flare (with bronchitis, sinus infections and ear infections) was treated successfully by increasing my Imuran and adding a steroid nasal spray along with several antibiotics. Lots of nasal rinses and warm moist air humidifiers were also very helpful.

Good luck in your treatment!

[jola57]

I could use some of those humidifiers right now, I have a one doozey of a cold/flu. everytime I cough (about every 10 seconds) my lungs feel like they want to be ripped out of my chest. Yess mother hen, I am seeing my family doc in 2 hrs. I probably need some heavy duty antibiotics. Its been 4 days of hacking. Its not even home grown but from my son when I was visiting him in UK (he had a tiny tiney cold). Sheesh, I can never realy win at anything, even when I finaly get a restful vacation it has to end this way.

[Sangye]

I hope you feel better quickly, Jolanta. Thank you for taking our mother hen advice before we gave it. LOL

[Jack]

Involvement that's limited to the nose and sinuses doesn't generally warrant ctx.

I can fully see your reasoning Sangye, but is not the one taken when I was treated all those years ago. The tactic used then was to smack down the first signs of a flare with a short, sharp dose of ctx. Admittedly, this did result in me using up my "safe" allowance, but it worked for me and brought me eventually to a sustained remission.

[pberggren1]

But now that way of thinking has changed with new meds and we have learned more about wegs and ctx and the other meds as well. So treating a flare with ctx now is the last resort.

[Sangye]

I can fully see your reasoning Sangye, but is not the one taken when I was treated all those years ago. The tactic used then was to smack down the first signs of a flare with a short, sharp dose of ctx. Admittedly, this did result in me using up my "safe" allowance, but it worked for me and brought me eventually to a sustained remission.

The Wegs specialists today seem to be increasingly against using the heavy-duty drugs for milder disease activity. In fact, the BVAS is designed not only to identify active diseaes, but to differentiate various degrees of involvement so the right meds can be used.

The hit hard strategy worked for you, but it has killed or harmed a lot of people.