have all classic ra symptons (inflammation, morning stiffness, significant pain in most joints, fatigue). Blood test came back above average for ra factors. Have family history of ra. Was prescribed Indocin (NSAID) before blood work came back. Doctor does not want to see me for another month..... Seems to be too long. Should I be pushing my Doctor for quicker treatment and referral to Rheumatologist?
Q: Positive for RA, how soon to start getting treatment????
Answers (6)
11/12/08 12:27pm
Having a chronic illness like RA means developing the ability to be an effective advocate for yourself as you navigate the medical system. When you have an acute problem, such as an infection or a sprained ankle, you tend to do what the doctor tells you, but when you have a chronic illness, it's a really good idea to work on shifting the "authority" in the relationship to you. You and your doctor(s) are a team and you are the team leader. It's your body, your disease and you're in charge. That said, using a little finesse and delicacy in the process of making this shift is a good idea, as you do need your doctor's cooperation in the process.
That said, in order to prevent damage to your joints, it's important to be treated as early as possible, which means you need a referral to rheumatologist sooner rather than later. I'm a little uncertain about why you doctor would tell you to come back in a month once the blood tests were in? The only reason I could imagine he would say that is if the NSAIDs are managing your symptoms fairly well. However, just as I recommend shifting your thinking to seeing yourself as a team leader, I'm also big on trusting yourself and the messages you body are giving you. And if you think that waiting another months is too long, make an appointment now to ask you doctor for a referral.
Good luck! Please let us know how things go.
11/13/08 11:07am
Your family doctor should give you a referral to a Rheumatologist as soon as possible. Medical studies have shown that the sooner you begin aggressive, biologic treatment the less potential for permanent joint dammage.
Your rheumatologist will probably prescribe some type of anti-inflamitory (NSAID, Steroid) in addition to a disease modifying drug (DMRD) in the beginning, like Palequenal, Sulfasalazine, Methotrexte, etc. It will take at least 6-12 weeks before these drugs have an effect on your symptoms, so don't dispair. You will have monthly blood-work done to determine the effectivness of these drugs for you. Depending on your outcome, he may modify these dosages and change the medication. Typically, they begin with more proven (cheaper, safer) meds, with less potential for side effects; then will progress to the newer (more expensive) anti-tnf biologics like Humira, Enebril, etc if your case is more severe and your outcome hasn't progressed positivly enough. We can all be thankful for the recent advancments in medications, as they have made this disease much easier to live with than in the past; and they're getting closer and closer the ideal, molecular cure.
Try to stay positive, keep your spirits up as this makes an impact on your body's ability to fight this disease.
May God speed your health and recovery.
your friend,
Bret
11/13/08 2:16pm
Your doctor NEEDS to refer you to a Rheumatologist as soon as possible. You need to start taking meds for RA now before you get joint damage. In my case, I had no insurance & couldn't get assistance from the drug companies, so my Rheumatologist couldn't put me on Humira or Enbrel because I couldn't pay for it. He put me on hydroxychloroquine & methotrexate which helped a little. In the year it took me to get insurance, I developed severe joint damage that resulted in me having my hips replaced, one in April & the other in June. I'm convinced that if I could have started on Humira or Enbrel when I was first diagnosed I probably wouldn't have had to have my hips replaced, at least not this young. I even switched Rheumatologists because I didn't think he was aggressive enough in treating my disease. My new Rheumatologist has helped me more in the last year than the first one did in 2 years. You know your body, listen to it. I'm not trying to scare you, but I don't want you to end up like me, 35 and had both hips replaced. Good luck !!!!!!
11/13/08 9:08pm
My family doc sent me to an RA Dr. right away. DR.Moldovan awhsome doc. He did extensive bloodwork and then when the bloodwork showed nonreactive RA, a full nuclear body scan. Sure enough I was shown the scan and the black areas or where the dye settled, was many and sure enough, exactly where I had pain. I chose the less side effect med Plaquenil 200mg 2xs a day, as he gave me the choice. He also found that I had a vitamin D difficency. Put me on vit. D with calcium 1000mg x2 weeks, then 500mg 1x aday.
Guess what ? It helped some of the pain. Just got an ok from my opthamalogist to start my plaquenil. It has been 3days and the side effects aren't too bad yet. Diarrhea & nausea. Dr. Moldovan, also advised me to find a pain managment Dr.to get on board. So, after all that lol Press to find an RA doc. the sooner you trear RA the less areas it will damage.
Look at it this way, no harm in getting a doctor for special areas, such as bones,eyes,mental health,feet,RA.
calawitch
11/13/08 11:51pm
You need to see one very soon. When I got it 26 years ago they did not have the treatments they do now that help slow it down and you don't get cripple like I am. Try looking into clinical trials also. I have done very good treatment for the last 9 years and I am up and out of the wheel chair with new medication and new joints.
Ask around if you know anyone who they also recommend
11/14/08 3:40pm
See the rheumatologist as soon as you can. I was Rheumatoid factor positive but it wasn't until the second rheumatologist visit that I was started on methotrexate. I started on prednisone on the first vist. I have only been on methotrexate for less than a month. It takes a bit of time to adjust to taking 6 or 7 new meds. I have started an exercise program (under medical supervision) which has really helped my energy levels and sense of control over RA. Having said that my RA has evolved since starting the methotrexate so the sooner you start the better.
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By KKPablo— Last Modified: 12/27/10, First Published: 11/12/08
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