Gather round, kids — here’s the plan

"Rituximab, you go long. Methotrexate, you hang here, then cut straight up the middle. . ." (Football play drawn by Vince Lombardi, 1958)

I talked with my rheumatologist this week about the plan for my treatment. She's recommending treating this disease quickly and aggressively, using the following handy 4-point plan of attack:

1) Rituximab: A chimeric* monoclonal antibody used to treat autoimmune diseases. Given by slow injection into a vein in a hospital setting. Initial dose will take 4–6 hours. Followup dose will be two weeks after the first. Potential additional treatment after about six months;

2) Methotrexate: An oral anti-metabolite, taken once a week, which decreases activity of the immune system, it is also used for chemotherapy against certain types of cancer. Developed in 1947, it is on the World Health Organization's List of Essential Medicines. (Who knew there was such!);

3) Once these two begin to kick in, we'll start to lower my prednisone dosage, with the ideal goal of getting off of steroids completely; and

4) Begin physical therapy on August 5.

* * * * *

Addendum: After speaking with the rheumatologist, I was thrilled to get the chance to Zoom-meet with Andrew Mammen, a neuroscientist who has written most of the papers I've been reading about immune-mediated necrotizing myopathy. In addition to being a delight to talk to, he was upbeat and helpful, saying that the suggested plan was exactly what he would have recommended. 

Another helpful takeaway from my meeting with him: Regarding my progress, I need to think in terms of months rather than weeks or days. Muscle regeneration isn't a popup overnight thing, I guess.

Rituximab case study here.

*Chimeric! I know there must be a medical definition for it but I don't even want to look that up, preferring the old-school dictionary meaning:

Chimeric (adj):  1) of a mythical animal; formed from parts of various animals. The design is based on a chimeric creature with the body of a turtle and the head of a dragon; 2) hoped for but illusory or impossible to achieve. The notion of tolerance is a chimeric dream.