We can choose to take the medications available to us that stop or slow down joint destruction, or we can choose to take nothing but anti-inflammatory drugs and/or pain relievers. In my mind, not taking a disease modifying anti-rheumatic medication, or DMARD, is equivalent to giving up. Anti-inflammatory drugs help with pain and inflammation, but not enough. Not enough for me, anyway!
My body and I are in this together. I choose to help my body fight my RA. My body is struggling, and it needs some help!
When I was first diagnosed with RA, my orthopedic doctor was concerned about me taking oral MTX. He said he would rather I take the injectable MTX. I explained that insurance will not pay for injectable MTX unless I try the oral medication first.
My orthopedic doc, whom I love dearly, went on to say that I could just treat my RA with anti-inflammatory medications and stronger pain medications than what I am currently taking. I told him that was not a good choice for me. The pain medication and anti-inflammatory medication do not stop my joints from swelling and hurting. He acquiesced, although he still seemed concerned.
I have been seeing this orthopedic doc for many years, and he is a good surgeon with a big heart. He did point out in our conversation that he is not a Rheumatologist. I have a good relationship with this doctor, and I know he said what he did only out of concern for my well-being.
I find it curious that so many good doctors know nothing about RA medications, except that they can have potentially dangerous side effects. They are concerned about their patients' welfare, but they do not understand the need for early, aggressive treatment to prevent joint damage.
I just happened to have an appointment to see my PCP this afternoon regarding another health issue. When I told her I am taking MTX, I was pleasantly surprised. “That is a good drug,” she said. I felt so “at home”. I have a PCP who understands RA. My PCP went on to say that RA needs to be treated aggressively to avoid joint damage. Hallelujah!
I'm sure we all have seen the advertisements for biologics, such as Enbrel and Humira, with the warnings concerning serious infections. All medications have side effects. From what I have read, most patients are successful at managing side effects. Some will have trouble with serious infections. Like almost everything we do in life, we must balance the potential risks against the benefits when deciding on an action plan.
In 2008 the American College Of Rheumatology (ACR) recommended prescribing MTX or ARAVA for most new RA patients. If the patient has moderate to high RA disease activity, they recommend MTX and Hydroxychloroquine, or Plaquenil. These medications are changed and/or added to depending on individual patient responses. We all need to work with our rheumatologists to find the right combination of medications that work for us.
I am not a doctor or health care professional. I am an RA patient. I used to be so opposed to taking any medication, except by blood pressure drugs. I had pain medication in my purse for three months before I finally gave in and started taking it. I was so, so stubborn.
The more I read about RA and how the disease progresses, the more convinced I am of the efficacy of DMARD therapy. I want to save my joints, so I choose to take the MTX, and whatever else my new rheumatologist prescribes. She is a good doctor, and I trust her.
It is my responsibility to eat a healthy diet, exercise when I can, and let my doctor know as soon as I suspect an infection is brewing. At this point, I am looking forward to feeling better. I am also thankful that there are medications out there to help RA patients. It wasn't so long ago that the only medications available were steroids, anti-inflammatory drugs such as Ibuprofen, and medications for pain. We are fortunate to have so many therapies available to us today.
We are all different, and we all have different medical needs. What are you going to choose to do regarding DMARD treatment? Do the benefits outweigh the risks in your mind?
Also take a look at Brad's sharepost on his experience with taking DMARDs.
Published On: June 06, 2011