I think the new treatment abalopeptide may have the same limitations as Forteo as neither agent has been shown to reduce hip fractures as far as I know. Comment of early RA and MRI studies, the "poor man"s" MRI is a definite dose related response to a modest dose prednisone taper. That's enough reason to start Plaquenil, if not methotrexate. Sadly, nothing is dirt cheap anymore including methotrexate sol'n which has been in short supply in the past. The cost of Plaquenil is sad testimony to this (not to mention colcrys). Finally, the presence of COPD (attributed to tobacco use or not) in RA patients on methotrexate should trigger testing for alpha-1-anti-trypsin deficiency as I know of a patient on long term methotrexate for RA who died of liver failure due to cirrhosis that was clinically silent, including regular testing of liver enzymes. Just a thought as it may not be cost effective for all RA patients on MTX.