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What can I take, other than leflunomide, for rheumatoid arthritis?

Q) As a patient with rheumatoid arthritis I found leflunomide very effective but unfortunately I do have history of bronchiesctasis. It had been stable for more than 40 years but leflunomide has changed that. The lung infections are under control again but I can l no longer use that drug. Which leaves a problem: what do I take?
Mr S Whitelaw, Kempston, Bedford, Beds (Spring 2013)

A) You ask an impossible question. What you take next for your rheumatoid arthritis depends very much on what you have already taken, the state of your arthritis and the other medical problems you have, such as bronchiectasis. Unfortunately, bronchiectasis is more common in people with rheumatoid arthritis. Bronchiectasis is a condition where the lungs are damaged. In the past measles was a common cause of this condition. It leads to repeated lung infections and progressive breathlessness. Treatment with immunosuppressive drugs can make the infections more frequent, and with bronchiectasis, finding the right treatment can be a challenge. I have used rituximab without causing the lungs to deteriorate but this does not mean it will be the right drug for you. Everyone is different.

This answer was provided by Dr Philip Helliwell for the Spring 2013 edition of our magazine, Arthritis Today, and was correct at the time of publication.

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