I understand your weariness. Autoimmune diseases like this (and I believe we are talking about the same thing) are malicious. Question: are your kidneys involved? The term granulomatosis implies that they are. If so your exhaustion could be a result of a low red blood cell count. Oddly although red blood is generated in the bone marrow, it is the kidneys that control the production. When my condition was active all I wanted todo was sleep. A transfusion and some injections of Procrit were required until my kidneys recovered enough to do their job. My doctors needed a kidney biopsy along with the previously mentioned ANCA values to determine my specific autoimmune condition. Bottom line: the response to all these conditions seems to be the same, you take some drugs that slow the reproduction of the fastest reproducing cells, those being the immune system cells (leukocytes?). That’s why the drugs they use are, or are closely related to anti-cancer drugs (another fast reproducing cell). Methotrexate I believe is also used to treat cancer and is very possible. I’m not questioning your RA doctors diagnosis or treatment. I just saying what I’ve learned.