The Four Courses of Rheumatoid Arthritis, part 2
Once you have looked over the four courses which Rheumatoid Arthritis may take, you might wonder, so what?
Does the course of my RA make a difference to my treatment?
Do I have any influence on which course my RA will take? That is the 64 million dollar question. And the answer is this: MAYBE.
All of the currently used DMARDs have the goal of altering the course of Rheumatoid Arthritis. There is a lot of controversy over whether that is actually possible. The American College of Rheumatology is urging doctors to use more aggressive treatments than were thought necessary only a few years ago.
The goals of treatment are remission, and then a cure. Meanwhile, what does this mean if you are an RA patient? It means get a doctor who wants to access your disease accurately, and then treat you as aggressively as possible, considering your apparent disease course. Tell him/her you don’t want to ride the Tower of Terror!
If you are on courses 3 or 4, and if the DMARDs scare you, try to learn as much as possible about what RA can do to you. That will scare you more! That will probably help you be ready to go on offense.
Remission is a tricky term
It is unclear what it is that brings about a remission. Usually, it is spontaneous. It is believed that, for some, it has can be brought about by a combination of DMARD medications.
Spontaneous remission tends to make us superstitious. It comes out of the blue. Whatever supplement was tried last is given credit. It is like the way we wear a lucky shirt because it might help the team win. However, none of these things bring actual remissions to people who are in the fourth group. Hmm… I think a real cure would.
How does the course of my RA impact my life descisions?
How does it impact my life decisions? Knowing more about RA and what course it may be taking can help you to make many other decisions. It always helps to know what to expect.
Here is a short list of decisions to which RA status is relevant:
* Should I have a baby?
* Should I buy a particular house (with hills, stairs, land…)
* Should I change careers?
* Should I live closer to extended family?
One of the worst things about Rheumatoid Arthritis is that we have no idea where it will hit us next. Knowledge will make it less mysterious. Let’s begin today with the big picture. And we will keep learning from there.
Finally, what difference does it make to one another? Some people with Rheumatoid Arthritis get remissions. Some don’t. Some have more permanent damage that continues during remissions. Some have less. Armed with these facts, we can understand one another better and not assume that everyone is like we are. Oh, and, by the way, I’d wear the lucky shirt, anyway.
Recommended reading:
- The Four Courses of Rheumatoid Arthritis, part 1
- Palindromic Rheumatism Is Not a Rare Form of Rheumatoid Arthritis
- Is There a Typical Rheumatoid Arthritis
Let me know if you are still on this website. I just received my diagnosis and I’m only 23! I don’t know if I should even finish school or even try to have a family! Does everyone feel this alone? Did you?
I think many of us do Erin. People write to me all the time saying that. My vote is to finish school and fight hard to do what you want to do!
Erin, I agree with Kelly. Everyone’s RA is different, and it may be that you will only be mildly affected. Its hard to predict how your disease course will run, even from day-to-day.
I have had RA for close to 20 years , and I was able to finish my bachelors degree in nursing, and also have a family. My sons are now almost 29, and 21. My disease has run a strange course, but it was milder in the beginning, and then got more aggressive. But like I said, we are all different.
Its been a journey to learn how to manage my disease. I try to take each day one at a time.I hope you find it encouraging that there are now , more than ever, a greater number of medications and research and knowledge, to fight the disease. Also, finding RAWarrior , and its support from other members , has helped me to feel understood, and find support from other RAers.
Good luck as you start your journey, Erin!
Wow! The 4 courses of RA is interesting. I am between a 3 and 4. My pain never goes away. It just feels worse some days. These articles were very helpful…thanks!!!
Kelly, I gave up the home of my dreams, which I designed myself, because of stairs and its size. I could no longer keep up with the cleaning and maintenence of such a large home.
I designed the next one with my daughter; single storey ranch style, and quit a job I had for 15 years which required being on my feet up to 12 hours, and sometimes more.
In spite of the constant pain I was living with, I was not diagnosed until 9 months later when I was referred to a rheumy who said I had fibrfomyalgia. 7 years later, an MRI helped diagnose the damage from RA, and it was decided I have both. I am still waiting for treatmebnt of the RA after we try Lyrica for the FM. Because any kind of diagnosis for a cause of the pain I was having did not come until 9 months after I left my job, I did not get disability; FM was not being recognized by the insurance companies yet anyway.I’m lucky to have coverage through my husband.
Erin, you are fortunate to have found this site. The support of wonderful people is so valuable. Good luck to you!
I am on a low dose of plaquinil and feeling better but not on remission . Does anyone know if taking a higher dose would help to bring on remission? Thanks.
Thanks for this site, it has really answered many of my questions even though I’ve had the RA diagnosis for over 10 years now.
When I was first diagnosed, it hit me like a ton of bricks. I thought of everything that Erin is thinking of, and after about a year I kind of settled into it and came to terms that this is just a part of my life. It doesn’t define who I am. I can be or do anything I want, sometimes just modified a little. For the most part, these days it doesn’t really even cross my mind. I wake up stiff, get my shower, take my meds and I’m off. I really never think about it for the rest of the day unless my pain is up.
Ever since my last visit with the rheumatologist though, I have been thinking more and more. He prescribed prednisone for the days when nothing else helps. The more I researched, the more I realized that I could be getting to the bottom of the barrel, treatment wise. I have been on just about every NSAID in existence, plaquenil, methotrexate, enbrel, and a lengthy list of others. My current treatment is mobic, methotrexate, humira, prilosec (for the acid reflux caused by all the nsaids), and now the sporadic prednisone. Everything I’m finding says that the last thing on the list are the Rituxan/Orencia/Kineret infusions.. which is where I’ll be when this current treatment has run its course.
To be honest, it really scares me. I am 30. I have been successful in life so far.. married, 2 step-children, bought a home, car, full time job, going back to school currently… So, I guess.. I’m kinda at that point again, just like I felt in the beginning. I can tell the disease has gotten worse. My fingers are progressively going crooked, toes are crooked already.
I would really like to know how long others have lasted before jumping onto the Rituxan/Orencia/Kineret? I am really afraid that by the time I’m 50, there will be nothing left other than pain management.
Hi Andrea, keep reading. There are about 9 options for injections /or infusions now and several dmards than can be tried in combination. It is hard to keep trying new ones looking for relief, but we are glad we have something to try too. Many patients (a majority) do use prednisone, at least sometimes to try to get through. Don’t give up!
Thanks so much for the encouraging reply :). I’ve been thinking about why I’m feeling this anxiety about it all, because this is really nothing new. I think what did it was the addition of the Prednisone. I’ve been on the same course of treatment for about the last 4 years, and the only things that have changed are my Methotrexate dosage and switching from Enbrel to Humira. It’s almost like when the Dr. added the Prednisone, ‘Another One Bites the Dust’ started playing in my head. It was a little discouraging. But.. everything will be ok, and I am not a quitter! Thanks again!
good way to describe it! I have all kinds of funny ideas for a video if we could use that song!
I have been fighting “something” for years. I have tried to tell my doctor I thought I have Rheumatoid Arthritis since I was 17 years old. Well the Fibromyalgia diagnosis came. Now my RF blood test has went from 21 to 22 in a year, so now it is that I possibly have RA. I have huge lumps on the top of my feet and I have red swollen areas of my ankle joints and the tops of my feet. The red swollen hot areas tend to hide when the doctor needs to see them and I have no clue why! The pain is always in my joints but they are not always red and hot. The pain is in both the left and right more prominent in the right. I am still and sore an wind up laying in bed and need help to get up after laying awake for two hours! I was told by the MD I needed to keep a “toilet pan” by my bed so I can slide off the bed and urinate so I do not destroy my bladder. The thing is ehem I can NOT move because I am so stiff and in pain. So a “toilet pan” by the bed is not going to help me if I can’t move, right?! Oh and my entire life has been on MD or another saying “THIS IS ALL IN YOUR HEAD AND WHEN YOU ACCEPT THIS FACT, YOU WILL HAVE FULL RELIEF!” The only thing is my psychiatrist says its in my body not my head! Oh yes I went to the shrink with the idea he could fix my thinking, when he seen the swelling in my legs he called my regular MD and requested I be allowed a second opinion. Hence the “over half of my life” with no treatment for the symptoms and my hands are starting to look as if they are “deformed” and my ankles are the same! My knee caps slide off at an angle and have “major damage” according to the X-Ray tech. Hmm I have to ask, is it ones mind if there are visible signs of something going on? The lumps that are red and hot on my feet can physically be felt and seen.
Sorry if this is not the right place for this!
I find this article very helpful as it appears to be I am either in the course 3 or 4.
Sarah
Thank-you, R.A. Warrior,
I just found your page. I have had R.A. for 7 years. (all alone) I don’t know anybody who has it and I think my Rheumy is only interested in the medications she can try out on me. I am on no meds right now. Just figuring out my food intake, and also what leaves my body is very very important. I ate bad yesterday so today I can’t type here to much with my big fat painful fingers. I will read everything here I can, and learn.After 7 years and all my internet searches, I still have questions and lots I dont know…again Thank-Yo for being here.
Cher Ballou
This site has given me many lightbulb moments…I am newly diagnosed, and have an appointment with my PCP later on today during which I assume we will discuss the best treatment plan for me. I am glad I took a look at this post about the four courses prior to this appointment!! I have realized that although I can function fairly well, I am never 100% pain free. There is always pain SOMEWHERE between the debilitating flares–which almost always affects my hands, lower back (the worst), and feet. Thank you, Kelly. I’m sure as I navigate this new territory, you will be a constant–and appreciated–companion.
good luck with your appointment Kimmy.
Thank you so much!! So many puzzle pieces are now fitting together, and I find that simultaneously comforting and terrifying. After reading through a lot of this site, I see I’m not alone in that feeling…
I fall into category 3. I’m in clinical remission which was brought on by my med pyramid of anti inflammatories, dmard and a biologic. My meds have definitely slowed down the insidious effects of my RA. I now take a narcotic because it enables me to work full time. How long will I be able to keep working? I don’t know. Will the meds eventually give me cancer? I don’t know. At 55 years of age, the cold weather is starting to affect me. I am able to do mild house work. Climbing stairs hurts my knees. I can go horseback riding once a year and suck it up that my back will hurt for a few days. I have food sensitivities and allergies I never had before. This is my journey. Laurie
This is too depressing.. I’m in my second year with ra and I’m ready to just give up, nobody understands or believes the pain I’m in. I’m taking methotrexate,humira and prednisone. It’s slowed down some but I install carpet for a living so it’s not enough. I’m 50 years old with no insurance,I can’t afford to start at the bottom in another line of work. I don’t know where to go from here…
I *hear* you. I wish I could offer an easy solution. I can tell you that the disease tends to change over time so you may get some improvement. Don’t lose hope of that. I still hope for that after 10 years because I know it’s possible. And either way – the thing we have to do is fight to stay as strong & healthy as we can.
Maybe your medicine doses can be tweaked. Or maybe a different combination would help more. Don’t give up. It won’t be easy, but fighting is our only choice.
https://www.rawarrior.com/live-like-warrior-3-lessons/
https://www.rawarrior.com/perseverance-in-fighting-rheumatoid-arthritis/
https://www.rawarrior.com/stages-of-rheumatoid-arthritis-heartache/
Cliff,
If you haven’t done so yet, get off or reduce your sugar intake. I know that doctors will tell you that diet doesn’t have anything to do with RA and I agree. However, over the past year I have slowly reduced my sugar intake and my symptoms have diminished. I also just feel a lot better in general. Perhaps it is just coincidence or I am in a period of remission but in any event and for general health it can’t hurt.
What if you don’t fit into the four?