Yes, I would consider using other DMARDs aside from methotrexate (MTX) if this drug cannot be used for whatever reason. In this scenario, for patients with inflammatory arthritis such as RA or PsA, leflunomide is a reasonable alternative to MTX. Azathioprine (AZA) is another option. LEF has the adva...

@Simon M. Helfgott: I do the same, but I am not so sure I can back it up with literature. Do you know of any that support AZA and LEF, other than some pegloticase literature? Interestingly, I think specialties may differ on this. I have a good friend, a very smart doctor who recently developed C...

I let the patient decide but I do try to start biologic and wean MTX if the patient elects for no q3labs/inflation/cost/appointments. Then if they flare, I say I am sorry we are adding MTX back see ya in 3mo (not a new start MTX). I wonder why Remicade monitoring similar to our GI colleagues infl ab...