Hi Reese,
I can't remember if we've ever "met" here before, so just in case we haven't, welcome to KA! Hope you find everything you are looking for here at our little corner of the web.
I know I'm late to the party here, so I'll keep this very brief:
1) Absolutely do not hesitate to find a new doctor if you feel that you aren't meshing with your current doc and that you aren't receiving a treatment plan that is aggressive enough to deal with your pain levels. Unfortunately, the reluctance to prescribe any narcotic pain-relievers is all too common in the doctor community, especially when dealing with rheumatologists. (Which I've always found odd--as the specialist, don't they see patients with more involved, and thus more painful, cases of AS and RA? So why do they feel they can't use every weapon available to them to reduce pain? So strange.) Bottom line, my feelings are identical to those of Steve C., who provided a nice response earlier in this thread.
2) Your current doc is correct when she says you have to at least try the methotrexate before you can advance to any of the biologic drugs (aka, the anti-TNF drugs). Almost every insurance company operating in the U.S. requires this "step therapy" approach to treating most diseases. Never mind the fact that, when dealing with arthritis, the sooner a patient starts taking meds that slow or even stop the structural damage associated with the disease, the better off the patient will be in the long-run and the less money the insurance company will have to spend. When dealing with a disease like AS, why can't they be smart enough to realize that even if the methotrexate (or perhaps even the first-step NSAIDs) work and reduce pain and inflammation, they can't slow actual disease progression like the anti-TNF drugs do? I guess it just makes too much sense to jump straight to Humira, Enbrel, et al, or at least more sense than the docs and pharmacy companies can muster.
Again, welcome to KA Reese.
Brad
