Mrs D you are very helpful indeed thanks. I do avoid alcohol now, am not on statins and have not taken any of the antibiotics you list. However I did sometimes drink more alcohol than I should have while taking MTX because it flagged up in my FBC - which was taken as part of my monthly toxicity blood monitoring.

It wasn't excessive amounts of alcholol by any means but my liver enzymes often became elevated as a result - which worried my GP. I know this sounds crazy but I was so desperate to come off methotrexate because of the awful taste and nausea that I wanted to be taken off it rather than reject it myself. So retrospectively I subconsciously became a tad reckless with my alcohol consumption I guess? Far from alcoholism but given I was on cytotoxic disease modifiers and have a delicate metabolism I wonder if this might have been enough to bring on an SFN?

I wonder if this is the real reason my rheumatologist didn't want to investigate my SFN and has chosen to keep me off anti rheumatic drugs perhaps?

Can you tell me whether a drug induced neuropathy would show up in a skin biopsy of small fibers or not? If not I wonder if I should bother because I'm now minded to just put my head down and bear the nerve pain as best I can - taking natural supplements such as fish oil as you suggest.

This way, if or when my RA comes back at least I won't be masking my SFN with other drugs and will know if my nerves have repaired? The pain is currently pretty awful but I'm getting used to it and practice deep breathing and it is preferable to additional drug reactions I feel.

I'm very grateful for your help on all this.