How do you know when the med isn't working anymore | Arthritis Information

Since RA is such a moving target and we all can have symptoms even when medicated to the fullest, how do we know when meds aren't doing enough? This seems like a dumb question -- but I've been keeping track of how often I've had to take pred to feel good enough over the past few months, and feel like it might be too much. I am on Remicade for a couple years now, and it does work, I think?, but my flare ups are still frequent and unpredictable (mostly deadening fatigue and soreness, not much swelling)

I am definitely better than before I got the drug. How do you know if the disease is getting worse/more active, or the meds are just helping less? Maybe it doesn't matter, either way -- I read about so many people who are medicated and are "ok" but still experience regular flare ups, so how do you know when you are at the best you can be? I'd love your insights on this...
Amy I can't answer your question, but wanted to let you know I wonder the same thing. I've had some increased activity over the last month and is it just a flare or is the enbrel starting to not work any longer? Moving from 1/week to every 5 days for two months to see what happens. When do you figure it's the nature of the disease and to just ride it out and when is it time for a med change? I'm much better than before, but also worried if it's a sign that things are getting worse. I guess I'll get my answer in June.

Sorry I couldn't help with your question.

Take care

Cathy

I am equally as confused. However I'm pretty sure I am at the point of adding another drug. I have to have a real heart to heart with my doctor at the end of the month. He wanted me to try a biologic after our last visit but I said I wanted to try the max of MTX instead. He said OK but I don't think you will get the result you are looking for. I didn't. But I want him to explain in greater detail the benefit of the biologic. Is it just to make me "feel" better or do I need it to fight my RA. I think they tell from the bloodwork--the inflamation--SED rate.I think when you're on the max dose of MTX and Remicade and still require 40mg of prednisone on a daily basis to function at all then that's a pretty good sign that it's time to move on. That's just my particular case..I haven't a clue about anyone else.

When I was in school to be a lab tech it was stressed to us that ESR is a very "generic" test and that it means nothing for the most part. And I've seen people with RA have very high ESR and little to no disease activitiy and vice versa so I do tend to believe that. Myself, my ESR was like 5 a few weeks ago but I'm a stiff as can be all day long. Not a lot of swelling (inflammation) but stiff as a board and a decent amount of pain.

Bob

HI Bob, just to let you know though, when you are on that amount of pred or any amount really, your ESR is not a true reading as pred masks the result. I am like you always in pain and stiff, not much swelling but some, and ESR sometimes does not reflect this according to my GP and RD, this is from the pred. Other times my ESR is raging and I don't have the accompanying expected level of pain etc.

I guess to me it doesn't really matter to me if the drug isn't working or if my RA is worse; I'd want to do something to stop the pain.

My RD told me soon after diagnosis that using prednisone more than once in a 3 month period is too much and he'll want to adjust my meds. His preference would be that I would never need it, but realizes there are times it is necessary.

kweenb2009-04-26 12:26:20Before I reached the place I am now I knew that when the pain was still there even with taking meds. or the pain returned well before it was to be expected.

Janie...oh yes I'm very aware that pred has a profound effect on ESR. It would have to as it's a highly potent anti-inflammatory agent. The thing is that I don't think my doc is aware..or maybe just doesn't care. My ESR was 5 a few weeks ago and I was still on 50mg of pred. and I was told that the remicade is obviously working well because my CRP and ESR was normal and that there was no noticeable joint erosions. Duh...HUGE doses of pred not only take care of the inflammation but has also been shown to have DMARD effects. Funny how she used to not want to even do an ESR on me when I would take like 10mg and was supposed to be taking 5mg but now that I'm on 50mg...no problems there.

Bob

Bob is right about the ESR thing. My RD told me the same thing, very generic and could be high for any number of reasons other that RA.

I believe, in my heart of hearts, you must fight this disease or it will get the better of you quickly. You are right, the best place to start is that heart to heart talk with your RD. Good luck and let us know how it goes!
This disease has already gotten the best of me. I'm nearly ready to give up on ever feeling much better. It seems that the docs around here only look at the numbers and don't listen to how the patient says they feel. Now I'm not saying that the numbers should be ignored that wouldn't be right. But sometimes they need to take our word for it when we say that we feel lousy despite what all the tests say. After all we live in these broken down bodies and would know when something is wrong before anyone else right?