The Controlled Burn Strategy of Disease Control for RA
Rheumatoid Arthritis medicines work like a controlled burn
Here in Central Florida, wildfires are a regular problem. Sometimes, it rains down cinders when the fires are miles away. Creepy until you get used to it.
However, I have seen several fires in my own neighborhood that were out of control. One season, we got used to going to sleep with the helicopters a mile behind our house “keeping an eye” on the fire for us. And last year, the fire came right up to my friend’s yard. Green on her side of the fence – black on the other. The firemen flooded the property line to protect her property.
The fires cannot be prevented. There is fuel. And there is heat. And there is a long dry season. So, there will be fires.
Instead, there is the strategy called “controlled burn.” The forestry service comes in and sets fires on purpose. But they do it for a good reason: they burn up some of the would-be fuel, hoping to prevent an “uncontrolled” flair later. Once, they burned right behind my house. It seemed like the swing set would catch fire.
Yesterday, when I did my shots, I thought how much they are like a controlled burn. My leg undoubtedly feels like it’s on fire. But that’s actually not my point.
It’s just that I’m doing something that appears to be harmful—but for a good reason. It is destructive. At least to the immune cells that die, it is. But, it’s for a good reason. The hope is to prevent an inferno of the Rheumatoid Arthritis through my entire body.
I have to put the methotrexate needle deep into the quad muscle. And sometimes, it rebels. There are spasms and pain for days. This week, I got new spasms on the left leg and the right leg is still injured from last week. (This is all on top of the site reactions from the Enbrel.)
But this is not the real danger. The shots and the side effects are merely a nuisance compared to the dangers of Rheumatoid Arthritis. That is like the wildfire: a menace which is difficult to get under control. And which produces irreparable damage.
Disease modifying medications (DMARDs) are the best thing there is today to put water between you and the RA. They are creepy until you get used to it, but the goal is to keep the green on your side of the fence. It beats the helicopters. They can be really loud.
Recommended reading:
- Wrong things doctors said: My Quest for Answers to Questions About Rheumatoid Arthritis
- UK Video: Working and Rheumatoid Arthritis
- Amusing list of terms I coined: From My Private Dictionary for Rheumatoid Arthritis
This was a excellent way of putting it! It is a easy way to explain to people that dont understand why we take our meds.
You always have a great way of communicating!
Hi Kelly
Please double check with your rheumatologist’s nurse on the proper administration technique for your injections and have her demonstrate proper technique. Also have her supervise you doing an injection to ensure you are using correct injection technique.
Methotrexate should be injected SC, subcutaneously, not IM (intra muscular) Improper injection technique is likely causing your pain symptoms in your leg and may cause an abscess, which is a whole different unpleasant can of worms.
Correct administration technique with injectibles is critically important, otherwise the drug cannot be absorbed properly by the body, and if its not absorbed properly, then the patient cannot achieve the best therapeutic effect offered by the drug.
Please see: http://www.poole.nhs.uk/our_services/rheumatology/drug_information/documents/methotrexateinjectionswebsite.pdf
Check with the nurse and have her demonstrate correct angle of the point for optimal sub cutaneous injection. Sub cutaneous is not IM! In SC injection, the medication is placed under the skin, but not into the muscle. Intramuscular inj. go right into the muscle tissue. There is a difference. Sometimes it can be very difficult for patients with RA to get the proper angle of the syringe for a SC injection, and it can also be difficult to manage the syringe itself and depress the plunger. Sometimes a larger syringe can help, but with a small gauge sharp (needle) to minimize skin trauma etc.
Hope this helps alleviate your suffering!
Fiona
hi Fiona, this post is a couple of years old.
Both of the rheumatologists that I had who prescribed me mtx instructed me to use it IM because of a higher rate of absorption. I’m aware that both are taught by various drs. It was frustrating to get an answer about whether it would be as effective SQ. The nurse did it w/me and or for me for 2 months insisting it be put into a muscle, but I’ve also read reputable hospitals do it SQ. There is a more recent post on the needles here: https://www.rawarrior.com/methotrexate-injections-for-rheumatoid-arthritis/ If you read this link, it talks about the needle compromise I finally came to.
Methotrexate is working great for me. I have been on injections for 16 months. My husband does my injections SQ with a tiny needle and there is very little discomfort.
I am 41 years old, a nurse, mother and physically active person. My father had RA and my maternal grandmother too. 2 years ago I had a periorbital psuedotumor and read everything I could about it (including a link to autoimmune diseases). My eye doc also mentioned in passing that I might be “more autoimmny”. Gulp.
Recently I developed tender joints (knuckles) without swelling or redness and a trigger finger. I got nervous, went to my GP and told her I was nervous about RA. Guess what… I am positive with the anti-ccp antibody test, everything else is normal.
Saw a Rheumatologist and started on Leflunomide this week. The controlled burn analogy is just what I need to try and go forward with these toxic meds. I do not want a rip-roaring forest fire. Thank you for the analogy.
Dear Kate, I hope the med works and your disease never goes full blown. That would be ideal. Sounds like you found a good doc who will treat early. Best of luck to you.