Dear Dr. Donohue • I was diagnosed with rheumatoid arthritis in 2005. My rheumatologist put me on methotrexate. I had many side effects from methotrexate, and it was not working as well as it had been, so my doctor put me on hydroxychloroquine (Plaquenil). The thought of going on needles scares me. I hate them.

My fingers are not disfigured, like some of those with rheumatoid arthritis are. What makes fingers crooked? I worry about what these toxic medications have done and will do. Now I need my vision checked every four months because of Plaquenil. — A.F.

Answer • Those medicines have saved you from the toxic disease rheumatoid arthritis. Unlike the more common variety of arthritis, osteoarthritis, which is limited to joints only, rheumatoid arthritis not only can destroy joints, but it can cause damage to many organs throughout the body. It leaves patients feeling wiped out. It can attack the lungs and the lung covering. It might inflame the heart covering. The principle for treating rheumatoid arthritis is to treat it early with medicines that can stop the progression of the disease. Truly, the illness is far more destructive than any of the remedies used for it. Take Plaquenil. It is true that it can damage the retina. But your regular eye checkups will show if retinal problems are arising, and, if they are, the drug is stopped.

The disfigurement of fingers that is sometimes seen with rheumatoid arthritis comes about because finger joints become partially or wholly dislocated. The fingers drift to the side and downward. That it hasn't happened to you could be the result of taking disease-modifying drugs like methotrexate and Plaquenil early on. It may never happen to you. The treatment of rheumatoid arthritis has been revolutionized in the past two decades with the drugs you have taken and with drugs called biologicals, which also slow the progression of this illness. They are given by injection. If you ever come to need them, you have to get over your needle aversion. They work wonders.

Dear Dr. Donohue • They think my daughter has cystitis of the bladder. She has seen doctor after doctor. What can be done? — F.C.

Answer • When people hear the word "cystitis," they think of bladder infection. Your daughter, I believe, has interstitial (IN-tur-STISH-ul) cystitis, an inflammation of the bladder not due to infection. It does have treatment. The oral drug Elmiron is one. Bathing the bladder with lidocaine (a drug that dampens pain) or DMSO, a drug that calms inflammation, often works. If your daughter hasn't seen a urologist, she should, or a gynecological urologist — a urologist trained in both gynecology and urology.

Write Dr. Donohue at P.O. Box 536475, Orlando, Fla. 32853-6475.