Rheumatoid Arthritis Requires Disease Treatment and Symptom Treatment
There is a difference between disease control and symptom control for Rheumatoid Arthritis.
There is no Rheumatoid Arthritis cure. You probably gathered that from yesterday’s funny blog. However, there are medications which can curb many of the effects of RA by actually cutting back the activity of the immune cells.
These are the medicines referred to as DMARDs: disease modifying anti-rheumatic drugs. The most common are methotrexate and Plaquenil. There are others, but those are used the most today because they are considered the most safe and effective.
Biologics like Humira, Remicade, and Enbrel are also used to attack the disease. Think of them as a newer class of DMARDs. For a very few people, DMARDs bring on a thorough and complete remission of the Rheumatoid Arthritis.
If you have taken them, though, you know that they are not a cure. They reduce the activity of the RA disease by effectively neutering some immune cells which attack us. But those immune cells continue to multiply and fight back. That’s one reason that I say this is like war.
The disease has its weapons – various B and T cells and the cytokines they produce. And you have yours – medications, nutrition, and various therapies. If we had a cure for Rheumatoid Arthritis, then we could fire that ONE weapon and be done with it. Someday we’ll be there.
Dealing with leftovers
Meanwhile, back at the ranch… We sit in our tank and fire our big DMARD guns at the Rheumatoid Arthritis disease. This way, we cut the enemy down to a more manageable size. However, then we still have to deal with what I call the “leftovers” – the many symptoms of Rheumatoid Arthritis which are left after the DMARD has delivered its blow.
To fight those, we use extra medications which include the following:
NSAIDs, which also reduce inflammation and pain, but less effectively;
Various other types of pain relievers or pain blockers, including narcotics;
Treatments, therapies, and medications for every other extra-articular symptom of RA such as drops for dry eyes, iron for anemia, heart disease medications, anti-depressants, or medications for relaxation and sleep, yoga, and massage therapy.
As warriors against Rheumatoid Arthritis, we usually try to take as little total medication as we can take – and still be able to live our lives fully. Most RA patients live with lots of “leftover” pain.
Why do Rheumatoid Arthritis patients live with leftover pain?
There are 3 reasons for this:
- We want to protect our organs from permanent damage due to long term use of too much medication.
- We want to avoid side effects of medications, which often compound some symptoms of the RA.
- We do not like being judged as weak by others because we are dependent upon medication.
It can be hard when you are deciding whether to take more medicine so that you can get out of bed or whether you want to save your stomach, liver, or kidneys. It’s like a game of Risk.
It is war. So we need to be strategic. If we are going to use any “big guns,” then they should be the ones which can do the most damage to the enemy.
If we were shopping, we’d ask: What will give me the most bang for my buck? Usually, that means giving priority to taking whatever combination of DMARDs will provide us the most disease control possible. Then, after that, we decide how we’ll go after the leftovers. We have to – so that we can function.
It’s not a perfect strategy, but it will do until the cavalry comes …with a cure.
Recommended reading:
- Do You Take Methotrexate for Rheumatoid Arthritis?
- I Failed the Rheumatoid Arthritis Control Quiz
- What is Sjogren’s Syndrome?
- 3 Reasons to Begin Using Rheumatoid Arthritis Medicines to Fight the Disease
- What Is the First symptom of Rheumatoid Arthritis?
Copyright © 2009-2010 Kelly Young, All rights reserved.
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Oh my gosh – this blog is wonderful! I am so glad I found it.
Leftovers – that is exactly what they are. Was trying to discuss this with my Rheumatologist today.
Robin,
I am going to go tomorrow…
Glad you found us too. Thanks, You made my day.
Thank you so much for directing me to your blog. The information provided is much more concise and easier to understand.
The only question I have is this: My doctor told me that I could be in the early stages of RA however he has not put me on the DMARDs mentioned on this blog and instead has me taking mobic and flexeril. He said it’s not severe enough for that stuff and he also said he didn’t want to put me on medication that no one would want to take me off of and he also mentioned that I was very young and he didn’t want to diagnose me with RA or another connective tissue disease, he mentioned seronegative Spondylitsarthopathy ( or something like that ). Is RA something that can be treated with DMARDs once it get’s severe enough or does it need treatment as soon as possible? Is it ok to wait until it really rears it’s ugly head? So far my doctor is going by my blood work. I had a low pos ana test at 1:80, neg for ra factor but I have all the symptoms of RA and another disease Lupus which has been ruled out.
He said I could have seronegative RA but didn’t (again) want to put me on the medication yet.
what would you do if you were in my situation? I had to have my doctor write out a letter of accomodation to my employer due to joint pain interferring with my job.
Thank you for reading this and for finding me on twitter maybe all of us in the same boat can make some sense of this weird disease.
Sheri.
Sheri,
I’m not a doctor, but I’ll tell you what I know.
If your doctor is not sure you have RA yet, then that is a good reason he has not given you DMARDs. If you do have RA, then, yes, the most current medical science says to get on disease modifying treatment asap. Are you seeing a rheumatologist yet?
There are 3 ways this usually goes at this point:
1) Maybe you will eventually get worse and it will become more obvious that it is RA.
2) Maybe you will do other tests or get a second opinion and find out that it is something else.
3) Maybe the whole thing will just go away. That is rare.
I tell people to do as much research as possible and to keep good records of your symptoms and your medical tests. Take all that info with you when you see a doctor and bring a list of questions to discuss with him.
Very often RA starts out slow like this. Pretty sneaky. But these are serious meds, so you need to be sure. It may take you a few months. I am sorry if that is not good news.
I love your words about “all of us in the same boat” together making sense! That is what I think too. When you have time, read some more of the blog. I put in a search box to help while I am getting all the new stuff fixed. I hope this helps some.
Kelly,
. I am seeing a rheumatalogist and have been for almost a year now. He has mainly tested me for lupus and RA, but mainly Lupus because the joint pain hit very suddenly overnight. It comes and goes. When I finally went to see my GP for the joint pain he ran a CBC and I had some abnormal results, a low platelet count and a low lymph count. That was when RA or Lupus was suspected. I had lupus ruled out finally last week and now he’s focusing on RA and the other disease. He asked me to keep a symptom diary and to take pictures of any swelling or face rashes. Those were turned in and due to what was written down Lupus was ruled out thankfully! I do have a striaght back, my lumbar curve is absent due to that issue he’s leaning towards Akalosing Spondylitis ( sorry for the spelling ) if it is not RA but I guess time will tell. It’s been a very difficult year being sent to doctor after doctor. I am sick of seeing doctors!
Thank you so much for your reply
I’ve done quite a bit of research and all the research into RA state that treatment within the first year of symptoms is very important. that is why I was asking about treatment with DMARDs vs. waiting for it to damage joints if that is what it is.
right now I’m just a big question mark, a sitting duck.
I’m glad you liked the comment we’re all in the same boat. In one way or the other.
Sheri.
I was just diagnosed with RA about 6 weeks ago by a rheumatologist. (seronegative), had been having problems and with pain in feet, had plantar fascitis, 5th metatarsal fracture–(while wearing clogs,stepped wrong on sidewalk), then had major emotional trauma, (my 24 y.o was killed in a car accident)to make a long story short, it has taken 2 years to finally be diagnosed—I have been thru peroneal nerve decompression surgery , trochanter bursitis—quite a few steroid injections in knee/hip. I basically started out with problems with feet/ankle, knees, hip pain/fatigue/ stiffness pain most pronounced in morning and after falling asleep on sofa and waking up in such pain. The orthopedic surgeon sent me to a rheumatologist when I started complaining of pain in wrists, and problems with stiffness/tightness in hands—/ he wanted to r/o fibromyalgia. When I initally saw him— they were questioning whether I had Rheumatoid arthritis, I was in alot of pain, I told him I have never had so much pain in my feet/knees, I was started on 1500 mg relafen, unable to take after a few weeks due to stomach issues- and then given a steroid dose pack, and started on celebrex. Which I have taken for 2 years. My GP drew blood for rheumatoid which was neg, and I continued with celebrex. —–anyway the rheumatologist drew a bunch of lab work, and x-rays, at my followup appt. She basically said she really thought I had fibro—–until she saw my x-ray—she was really concerned . I have damage to both of my wrists, and right ankle. joint space narrowing on 2 fingers, and an erosion starting on one of my fingers. She said according to my x-rays I have had ra for about 1 year. I am currently taking methotrexate 10 mg/wk, and 1 mg folic acid daily. I don’t have severe pain on a daily basis—its more like a low level of discomfort that I deal with, it is up and down, I am a nurse and work on my feet , which is the worst on days I work, and am very fatigued, I also am currently having alot of discomfort in my fingers- stiffness in am, and problems with them not working right/ and wrist discomfort., but not very obvious swelling. I am currently not taking celebrex, this is after not being able to stop for 2 years. It seemed the rheumatologist would prefer I not take it with the methotrexate, but said I could if I really needed to. I am taking motrin if needed.—-
for anyone considering not taking meds to stop the disease I think you should reconsider— I already have damage to my joints within the first year.
kathy
Intersting discussion!
I tell my patients that in advanced stages of RA, DMARDs and especially biologics might control inflammation, but pain might still prevail, because pain might be a symptom of post-RA OA. So symptom control is as important as disease control.
One word to Sheri: as long as the diagnosis is uncertain, one shouldn’t use DMARDs, especially if seronegative spondyloarthritis is in question. But your doctor should come to a diagnosis soon!
OT: One German politician lately made a speach in English: “Here in Germany we all sit in one boat!” LOL
To Kathy: Thanks for this interesting information. One should look if the rheumatoid factor stays negative and if the anti-citrullinated protein/peptide antibodies (ACPA)are positive or not.
Best wishes to everyone!
Lothar
I, too, appreciate this post. Much food for thought here.
And I will share my past year’s experience to add to the pot – through the murkiness of diagnosis for RA. I am sero-negative something. The only thing positive in my labs is for AntiPhsophlipid Syndrome (with one DVT). But fatigue, bilateral stiffness, unreal pain & some swelling in hands, feet, wrists, elbows started suddenly last winter. There’s mild X-ray evidence of joint damage. I was put on Plaquenil for the APS & Ultram for the pain. I felt only worsening of symptoms through the fall of ’09. I had cut back on my hours at work as much as I could afford.
In October, I sort of begged my rheumatologist for a trial of methotrexate because I kept feeling worse. Life was limited, to say the least – as many here can relate to. Now after five months of MTX with an occasional Darvocet on flare days (DC’d Ultram), this sero-negative something is no longer worsening. I have regained some energy, stiffness is less – and this new energy improves my pain tolerance. The rheumatologist has diagnosed this as RA for now – and she thinks it will clarify itself further with time. Was this the wrong approach for a sero-negative situation?
Hey Marge, maybe the doc will come back to reply later, but here is a link you might have a look at. At least a third of RA patients get negative blood tests, so we need to rely on some other diagnosis methods also. There are other tests and there is the method you are using too – to see what works.
Very helpful & reassuring, Kelly. Thank you.
Marge, the decision, which DMARD to take first is made in the light of disease activity. Our approach is more hit hard and early. If the diagnosis is made, then establish an efficient DMARD therapy – and this would be methotrexate. Especially if there’s already “mild X-ray evidence of joint damage”.
But I wouldn’t call it a wrong approach. Plaquenil might also work on seronegative RA.
Thank you for clarification. It’s such a complex issue. But I’ve learned much here.