It All Comes Out in the Wash: Comparing Different Treatments & Approaches

unwashed hairFour weeks. Not a record for me, but close… When this is published in the morning, I’ll be spending the morning washing and blowing out my hair for the 1st time in about a month.

The ends started to take dreadlock form the last few days, somewhat an improvement. But the front looks really bad [deliberately not in photo]. My neck is a bit better today and I’m going for it! It will be a very long day of errands, meetings, and phone conferences, but it will feel good to look “normal.”

Does that sound random? Bear with me.

Yesterday, I was speaking with someone who needed to understand RA patients’ point of view for her project for a pharma company. And she didn’t (understand).

Giving her free advice, I told her that my neck and hands have hurt too much to make it worthwhile to wash my hair. She hesitated to believe me, maybe because she’s been told that medication helps everyone with Rheumatoid disease to feel close to normal on most days, with maybe occasional flares.

Finally, I told her: Look, there is a small percentage of people who have remission or mild RA who can do the things you suggest, but that is not your audience anyway since your drug is for people with “moderate to severe RA,” right? Make sure you don’t insult anyone…

Of course, people with RA do not yet have THE silver bullet. And researchers know that. That’s why they investigate how treatments stack up against each other. Here are two interesting studies I’ve read recently.

Seeing “very little difference among the current biologics”

In “Abatacept versus other biologics in methotrexate inadequate responders with rheumatoid arthritis: you like tomato and I like tomahto… let’s call the whole thing off,” Yusuf Yazici (a colleague of Dr. Ted Pincus), comments on current studies that compare biologics: “(A)s far as efficacy is concerned, there is very little difference among the current biologics.” Yazici says there are more pressing matters to explore to improve patients’ lives. “It is time to stop picking favorites among the biologic agents and focus on how we can get more physicians to monitor RA outcomes that would allow us to be as aggressive as RA demands us to be.”

Comparing less expensive triple DMARD therapy to Enbrel plus methotrexate

Over several years, the TEAR Trial has examined early, aggressive RA to compare oral DMARD combination therapy (methotrexate, sulfasalazine, and hydroxychloroquine /Plaquenil) to methotrexate plus etanercept (Enbrel), asking:

  1. Whether any combination therapy (three DMARDs or methotrexate with etanercept) is more effective than methotrexate alone, with a step-up approach.
  2. How does combination therapy compare to methotrexate plus a TNF Biologic?

RA Tear Trial fig 3

“The treatment of rheumatoid arthritis (RA) has changed dramatically over the past decade” and there is a need to know whether one approach is proven to be more effective, especially considering how costly Biologics are. The primary outcome of the trial was the popular disease activity score, DAS28-ESR between weeks 48 and 102, and this showed no difference between the two treatment approaches. However, the etanercept plus methotrexate patients had a “smaller increase in radiographic scores” (x-rays of hands, wrists, and feet).

More interesting points: “We observed a higher rate of participants not completing the study than we had originally expected.”  Dropout rate was 32.1%, and most of those who decided not to continue cited lack of efficacy or did not provide a reason. The screenshot of figure 3 shows that both immediate therapy (IT or IE) groups had more patients who reached ACR response levels than those with step-up approach.

Nope. No silver bullet yet. Of course the marketing folks can’t talk to the researchers, but I wonder whether the researchers laugh when they watch the commercials that make treatments seem like a cure. Anyway, I hope both of them will talk to patients more.

Recommended reading

Kelly Young

Kelly Young is an advocate providing ways for patients to be better informed and have a greater voice in their healthcare. She is the president of the Rheumatoid Patient Foundation. Kelly received national acknowledgement with the 2011 WebMD Health Hero award. Through her writing, speaking, and use of social media, she is building a more accurate awareness of Rheumatoid disease aka Rheumatoid Arthritis (RA) geared toward the public and medical community; creating ways to empower patients to advocate for improved diagnosis and treatment; and bringing recognition and visibility to the Rheumatoid patient journey. In 2009, Kelly created Rheumatoid Arthritis Warrior, a comprehensive website about RA of about 950 pages and writes periodically for other newsletters and websites. Kelly served on the Mayo Clinic Center for Social Media Advisory Board. There are over 42,000 connections of her highly interactive Facebook Fan page. She created the hashtag: #rheum. Kelly is the mother of five, a home-schooler, Bible teacher, NASA enthusiast, and NFL fan. You can also connect with Kelly by on Twitter or YouTube, or LinkedIn. She has lived over nine years with unrelenting Rheumatoid disease. See also

17 thoughts on “It All Comes Out in the Wash: Comparing Different Treatments & Approaches

  • April 20, 2012 at 8:07 am

    My pain in my neck, hands, wrists, elbows& shoulders has been so bad I’ve been thinking about braids or a weave do I won’t have to wash my hair every few days. I went natural for easier maintenance and to showcase my natural curls, but it takes upkeep too. No curling irons but detangling…I’ve been close to locs too. But I haven’t decided to locus hair yet! Lol! Thanks
    Kelly for always sharing and educating. (((hugs))) sister!

  • April 20, 2012 at 1:43 pm

    I grew my hair out specifically so I could pull it back into a ponytail and look put together. I didn’t have the energy for doing anything to it even every other day. Now it is so long I’m running into a new problem: it would work better in a braid, or even better a french braid, but I’ve discovered I now longer have the ability to work my hands behind my head to do it. I may have to teach my husband how to do a french braid and have him do it for me some days before work.

    Anyway, ARGH on the not getting it. I think that drug rep just doesn’t understand just how serious autoimmune diseases can be. It’s not like a headache. Sheesh.

  • April 20, 2012 at 3:14 pm

    Kelly, I understand. Some days I don’t even feel up to getting dressed, and I stay in my comfy PJs till the body starts to loosen up…
    Re the studies: what always strikes me are the ACR 20/50/70 criteria (20%, 50% or 70% improvement.) There are so relatively few who get to 70%, and even that is not remission.
    I was very lucky to be at probably 70% improvement on Enbrel but unfortunately had to go off it because of adverse effects. But 20% as a criteria? My symptoms vary hour to hour, day to day, and I am sure there is a 20% variation even without change in meds, so it seems a very weak criterion. Although I understand that for some it may mean the difference between getting through the day vs. being immobile, but still… to consider 20% improvement as a satisfactory response seems an over-reach, and contributes to the misconceptions about effectiveness of treatments.

    • April 21, 2012 at 9:11 am

      All good points and arguments I’ve included in discussion as I present our point of view. And all of these terms are relative and subjective, even joint counts are not objective measures becuase patients “count” differently than drs count. Another confounding factor: some people have only some joints affected. Others have all joints affected. So, the measures do not directly compare.

      I don’t know how people would react, but I don’t really have “good” days physically so I work in pj’s or sweats pretty much all the time at home. Getting dressed is one of the hardest parts about traveling because once I’m dressed I want to go lie down, but the day is just beginning.

  • April 21, 2012 at 5:42 am

    I fully agree with how hard/tiring and painful hair washing and drying is.I find that sometimes hair washing etc. is my main goal/achivement of a day. The worse the R.A.D has got the shorter my hair is!

  • April 21, 2012 at 6:41 am

    I’ve not washed my own hair in years, my fiance does it for me. I cut my hair short a few years back as I was struggling to look after it, but I do miss slightly longer hair.

  • April 21, 2012 at 2:50 pm

    It’s not pretty, but it’s the truth…. it should be in an RD commercial…

  • April 21, 2012 at 11:56 pm

    I’m having a bad fibro fog day today, so forgive me if I’ve posted this before, but thank you for addressing not only the med situation, but also the fact that the pharma companies seem to have no idea what real people with auto-immune diseases deal with. I hate those stupid Enbrel commercials with Phil Mickelson, because my sons will see them and ask why I don’t take that so I will be better. It is such a dis-service to those of us who are crippled and suffer daily. It’s difficult enough to explain RA to all of those who confuse it with regular arthritis, without the drug companies proclaiming that if you only took their brand you would be perfectly well again. Thank you for representing us so beautifully. God bless. Gay Nell

  • April 22, 2012 at 4:07 am

    Short hair here too. Too many other things to try to do in a day. I prefer no worry about hair, or shoe laces. Just getting socks on is enough on the bad days.

  • April 24, 2012 at 1:12 pm

    You are so right about the hair. I’ve had what I like to refer to as my “dreadlocks” many times over the years. Medium length,curly,humidity…Yep, they were right there on the neck. But I have learned to love them. Who wants to look “polished” anyway? Glad you could do your hair again.

  • April 25, 2012 at 1:32 pm

    I was part of the TEAR study out of University of Alabama, Birmingham. I took active part in the study for 2 years. Had just been diagnosed with Agressive early RA, thank G-d for my wonderful clinic who takes part in studys. The pain, fatigue and being very frightened went away very quickly. I don’t know which drugs plus Mtx I was on the first 18 months, I only know that in the last 6 months of the TEAR study I took Enbrel and methotrexate once a week. I had to mix my own vials and learned how to inject. My Dr. said they were seeing if heavier doses with biologic drugs + Mtx in the very beginning was more effective than increasing the drugs as the disease progressed. In my case it was more effective. It knocked my inflammation and joint damage down and carried the results over 3-4 years while taking 8 tabs of Methotrexate only, once a week. I’ve been back on Enbrel again for 1 1/2 years and doing well. Blood work done every two months is fine. My sed rates continue to go up and down, but we don’t know why. My Dr. said we will rely on my description of how I feel and how active I can be. When I asked about my general progression and what I might expect in 5 years from now… Dr. replied, “I am very optimistic”. (words I love to hear)

  • May 5, 2012 at 9:16 am

    All that “vanity shall come at a price…” not only did I never believe it – I thought it was ridiculous.

    Until vanity did indeed have a painful price- urhg… I know I hate a whiner too – but it’s just plain unfair that a girl has to blow dry with hands that have recently been run over by several trucks. Agreed?

    it’s worth it – fresh hair – high heels- blessed be- but hell on the getting.


  • May 5, 2012 at 2:49 pm

    Thank you….this is all I can manage to say. Thank you, Thank you, Thank you. For the past 5 years I have been beating myself up mentally and blaming myself and my being weak on various mental aspects of myself….I’m lazy, I’m dumb, whatever the day brings. You have made me realize it’s not me….it never was, and I am not the only one going through this.
    After 31 years of suffering with RA, the past 5 being the worst…you have given me relief in knowing I am not a bad person or a weak person. I am a fighter, and I’m not the only one getting beat up every day because of it. Thank you

  • May 7, 2012 at 3:40 am

    Thanks for your very accurate and humorous take on RA. Sad that they seem to get it wrong all over the world. I’m in South Africa and also going through the 40 pills a day regime. I told my Specialist my tablets caused me to vomit non-stop for 3 weeks(lost 20 pounds). She looked at my wrists and said:” AT least it’s working – you’re joints aren’t as swollen anymore!”…Yes…I am SOOO happy the treatment is working so well 🙂

    • May 12, 2012 at 1:45 am

      So true!!! Now I can hold myself up over the toilet as i puke. That IS so much better. Hope the 40 pills a day work. Keep in touch.

  • February 18, 2018 at 9:38 pm

    I am so thankful for your wonderful site. It helps me get through many days when I realize I am not alone. The info is so helpful and I love the humor in so many posts. Gentle hugs to all!


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