Dr. Clem Michet and Dr. Nisha Manek on Rheumatology

This Mayo Clinic Medical Edge Weekend episode features Mayo Clinic rheumatologists, Dr. Clem Michet and Dr. Nisha Manek talking about rheumatology.

Medical Edge Weekend 12-5-09


  1. Jake Jacobson
    Posted December 5, 2009 at 10:58 am | Permalink

    I’m a 46 yo man w/RA for 10 yrs. Treatment included sulfasalazine and plaquenil together now doing methotrexate for the last few years- up to 8 tabs per week and I’m still not responding very well. What do you think I should try next or talk to my dr. about? My doctor doesn’t seem to want to try anything new that’s out there.

    Thank you,
    Jake Jacobson
    Orange County, CA

    • jstreed
      Posted December 7, 2009 at 5:05 pm | Permalink


      Thanks for your question. Here is the reply from Dr. Manek:

      The traditional treatment for RA is a combination of disease modifying treatments: Usually this consists of Sulfasalazine, Plaquenil and Methotrexate (all 3 together). If a patient has continued activity of RA on combination Rx’s, then one option would be to change methotrexate to higher doses (up to 25mg) by subcutaneous route (injection) or to Arava (Leflunomide). Other options include the biological treatments (Remicade, Enbrel, or Humira and now also, Certoluzimab or Golimumab). At Mayo we are doing a study to compare the combination treatment as above (sulfa + Plaquenil+ methotrexate) to a Enbrel + Methotrexate combination.

      Omega-3 supplements (Fish Oil – 2g to 3g daily) may also be helpful.

      • Jake Jacobson
        Posted December 19, 2009 at 7:41 am | Permalink

        Thank you for all the information and your reply.

  2. Roxanne Carns
    Posted March 19, 2011 at 11:06 am | Permalink

    I am 50 years old and suffer from extreme muscle pain in my arms, legs, and shoulders. This pain travels all over on both sides of my body. I have tingling and burning in hands and feet also. I have been to 10 doctors and have many different diagnosis. Some of them think it is Fibromyalgia. Should I see a rheumatologist? The first rheumatologist told me I was in menopause, because all my blood tests and MRI’s came back clean. Help! My regular doc finally put me on Savella. I am barely able to work and have cut my hours alot. Don’t know how long I can hang on. Thank you, Roxanne

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