About six months ago I started waking up with some pain in my feet, then my hands, then full-blown,

Hi,

For some reason it cut off the paragraph I had written.

My question, in a nutshell, was about drugs.  I had a bad flare and within a few months was diagnosed with rheumatoid arthritis.  Over the course of those months of doctor visits, the RA really quieted down.  I no longer have the fatigue and am maybe 10% physically diminished, with some pain and stiffness in the morning.  But I'm back to ballet, kickboxing, etc.  I'm thinking that my rheumatologist is still going to want to put me on drugs, and I'm wondering if it's safe to forego them and just take my chances.  The side effects, to me, seem like they would be about equal to whatever discomfort I'm feeling now.

I'd recommend you have a discussion with your rheumatologists about this, weighing the pros and cons of treatment. If you are more or less in remission, you may not need any medication. However, it if there is some disease activity, treating it with a low dose of e.g., prednisone or Plaquenil (or any of the other DMARDs that are lower on the treatment ladder) will protect your joints from the kind of damage that will impact your future ability to move. Keep in mind that even though you may not be feeling a lot of symptoms, the disease may still be active enough to work on slowly damaging your joints and you don't want that to happen.  The goal is to keep you as healthy as you are now with no further damage to joints and that may need some medication.

I'm sure there is some disease activity, as I don't feel 100%, but is there always damage to the joints?  I guess I'm being a baby about not wanting to take the meds and deal with the side effects! 

I just can't find ANY current info on people who decide to forego drug treatment, wheareas in the past, it seemed like doctors would hold off on the heavy guns-- surely some of those people did okay in the long run.  Maybe I could be monitored with X-rays?

Even if your disease activity is very mild, there is a risk of joint damage - how large that risk is this something you should discuss with your rheumatologist. Monitoring with z-rays is iffy, as changes don't show up on x-rays until the joints are damaged.

One of the reasons that doctors would hold off with the "heavy guns" in the past is that there wasn't really any ammunition against RA.  Now there is. In the past, you might be able to be treated with some of the drugs that on the lower rungs of the treatment matter for RA (methotrexate, Paquinil, etc.) and for people who have mild cases of RA, this would probably keep them going for a long time. However, for those of us who have moderate to severe RA, without effective treatment, we were looking at joint damage, mobility changes and deformities.

RA has been known to go into remission spontaneously, but to be honest, it's rare. With the new treatment modalities like the Biologics, approaches to treating RA has changed significantly to treating early and aggressively in order to keep people at a minimal level of damage for as long as possible - Enbrel, the first of the Biologics, has been around for a little over 10 years and I've met people who have been on that drug for a decade and are still doing fine.

That said, given that you have what appears to be a very mild case of RA, should your rheumatologist recommend treatment, it will likely be one of the "milder" medications, like Paquinil or sulfazalazine, both of which tend to have very mild side effects (if any). Last year, I wrote a post about managing side effects and if you do go on a medication and end up having effects, it may be helpful to you.

I would recommend that you have a very honest discussion with your rheumatologist about the pros and cons of treatment and your fears about medication. Knowing what the consequences of whatever choice you make will be will make this an informed decision for you.