Wow Your Doctor got out the big guns for your arthritis, methotrexate is very potent stuff it has been around for quite a while and is a chemo drug for Cancer. As I am sure you know Golitho impeccable dental and mouth hygiene is a must when your on that medication! Like so many of the drugs now days they were originally made to treat one thing and they they found if you changed the dosage that same drug is good to treat something else. Reqip and Mirapex are excellent examples, the original medication was used to treat Parkinson, they lowered the dosage and renamed it and use it to treat Restless Leg Syndrome.
Golitho I don't think you do need to talk frankly with your doctor and together establish a reasonable goal for control of your arthritis, ask your doctor if your expectations are to high or unreasonable, maybe you will have to alter your goals some what. But if you do, it should be done together with your Doctor, the same goes with managing your pain, you really need to sit down with your Doctor and talk at length about your pain, and then as a team come up with a reasonable plan to keep it under control!.
Provigil works very well for some people, like Chutzie, others it is not as effective, so if your Doctor prescribes it for you, don't get your hopes up real high, and then if it works well for you it is bonus, and if it doesn't it won't be such a let down. It is a very potent drug though and should be used with caution.
I do wish I had better advice to give you, or better yet, just be able to make your arthritis and pain go away! But since I can not do that, I will just tell you that I do care and I do wish you all the best, and hope that you will start feeling better and have less pain.
Your in my Prayers
I'm Retired USAF, went back to school and became an RN, and now am on full disalbility!--Degenerative Disc (affecting mostly the thorasic disc but all levels involved), C6/7 laminectomy/diskectomy& fusion, Osteoarthritis, Ulcerative colitis, Chronic Pain, Fibromyalgia, Complex Sleep Apnea, and host of other things to spice up my life!(NOT!) Medications: Oxycontin, Percocet, Baclofen, Sulfasalazine, Metoprolol, Folic Acid, Supplemental O2 at 3lpm with VPAP Adapt SV