What is the goal of the RD? | Arthritis Information

 

I have a question. I go to my Rheumy with all these questions but by the
end, I don't seem to get them all answered, probably because it would take
hours. Is the goal of my treatment to get all the inflammatory lab markers
to a normal level? or is it for me to be symptom free? My sed rate is right
on the borderline of high normal (24). But my CRP is 9.5. That is down
from 28 a year ago. He was pushing another med and I said no. I'm 80
percent better, not 100 but I'm thrilled about my progress. I'm only on
Plaquinil. I have been on this med for 3 full months and he said this is as
good as it is gonna get on this med. Is this true? What have you all
experienced with this med. Is my CRP that high...still a problem? I am a
nurse but cannot seem to get these questions answered. Will a 2nd med
help my labs normalize? Do I care as long as I feel better? Thanks all for
being here.

I can't really answer the questions about your blood levels. But, and this is only my opinion, if you feel that you are getting enough treatment at your current level and no further joint damage is occurring, I would be inclined to stay with what you are doing. But the key point is whether or not you disease is still progressing. That might be why the doctor is pushing another medication. Your bloodwork would seem to indicate that.

Maybe you could have that kind of discussion with him. You want to keep your treatment conservative because after all these other meds do caring some big risks. Yet, you don't want to have permanent damage occurring. Maybe he can do some borderline xrays/films to track things so that you are both comfortable about the level of treatment you are getting. He could also set some parameters for you as to when to make a trip back into his office if things start to digress.

I think it is great that it is working so well for you.

Up until September, I was on only MTX (15mg/wk).  I thought I was doing well, and all my labs were normal.  But I did still have some swelling in my hands and ankles.  I had some x-rays done, and they did show some minor joint damage.  My RD convinced me to add Enbrel, because even though my labs were normal, joint damage was still occuring.  I've been on Enbrel for about 3 months now.  It is helping to keep the swelling down.

If it weren't for the joint damage, I would have been happy to stay on the MTX alone.  I felt that I was in pretty good shape--able to exercise and do almost everything I wanted.  It was a tough decision for me to add the Enbrel--but I finally decided that if possible, I want to avoid joint damage.

I don't know if this helps to answer your question--but I do agree with Deanna--xrays would be helpfup to see if any joint damage is occuring.

Good luck--
dordale Hi, lorster! This question has been answered a few times here. Many of us believe the blood tests are NOT in themselves conclusive but act as signposts. This opinion is supported on many web sites, including those dealing with ESR. In my case the rheumy can see no major clinical signs of RA (MTX and prednisone) yet my ESR remains at over 100. It seems it's good if the ESR does come down but is not critical. Being 80% better is a huge step after 3 months, perhaps give it another month or two then consider adding to or changing your meds. Hope this helps and good luck - Des. I also had xrays of my hands done yesterday. He said feet xrays are no
longer relevent to the progression of the disease, hands only xrays are
sufficient. I have not heard from him so I must be ok. I do not have side
effects from the plaquinil and I just hate the thought of going on a second
med and have to deal with my hair falling out etc. I don't have any more hair
to lose due to the disease itself. I thought that joint damage only occurred if
the joints were painful. Is this the case? I really hate having to deal with this
disease. Its like having a 2 year old in the house, lol...constantly watching.
Anyway, I hope you all are having a good xmas season. You can have joint damage without pain. That's why it is so sneaky. But if they did x-rays and those or good, wait and see might be good. I think following your own instincts are the best. My labs look great and always have but my joints are red, swollen with damage starting.  So much for just having great lab numbers.This is such a strange depressing disease. No two people seem to follow the
same course. The other night I was at the grocery store and I looked down
and my left thumb joint was bright red and hot. It never hurt. 24 hours
later, it was normal. This is the first time I have had redness. Mostly
swelling and pain. The clinical numbers do not seem to match the physical
symptoms. Maybe that is why it is so hard to treat.
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