Thanks. That very helpful. I do take Orencia for the RA along with sulfasalazine, plaquenil, prednisone and Celebrex. I also use Voltaren gel on my knees. Perhaps it's time to try a different biologic. I've tried Enbrel and Humira and was on methotrexate for many years before trying them. After my shoulder replacement in 2012 the methotrexate didn't work since I was off of it for about a month because of the surgery. I see my rheumatologist July 20th so I'll see what he thinks.
Thanks again.