The most important thing you said was Bupa. This will get you seen and re-seen in timescales that the NHS just can’t match (in my area anyway). Get to know your specialist nurse, she/he will be more useful to you than the consultant for on-going treatment and questions. Not dissing the NHS, the team that have helped me have been excellent, to the extent both the nurse and consultant retired due to burn out!
For me methotrexate helped a little but became (after 2/3 years of tablets) unbearable due to the nausea. I’m talking a couple of days of constantly feeling like you’re about to puke after each dose. They tried me on injections in case it was a tablet reaction (i.e. me!) but just as bad.
My salvation was Humira (that is a brand name I think). Cost a lot of cash at the time so there was a reluctance to let me have it but it has been transformational for me. One injection at home every two weeks and some other tablets daily. Rarely use the anti inflam tablets now.
Key to getting it was being honest in the quarterly review questionnaires that they ask you to complete (describing pain levels and mental well being). I was being too ‘stiff upper lip’ about it all so the data suggested I wasn’t doing too badly. A conversation with the nurse on how to explain the pain and 6 months later the Humira was prescribed. It might be easier to get it now as the patent has expired.
I have AS btw