Treating early RA | Arthritis Information

 

From everything I've read about treating early RA, it seems that combining a DMARD (like methotrexate) with a biologic yields the highest rate of disease remission.  I even read about a study in which three types of DMARDs (MTX, Plaquenil and the third sulfasalazine) were given along with fish oil, and gave far superior results than any one alone. I think the point of that study was to find a cheaper treatment than one that included biologics.

I'd love to learn from folks' experiences, knowledge, etc. on treatment.  What do you think is the best way to treat early RA? What do your doctors say? What do you wish you'd done differently when you started treatment?
I wish I had been Dx'd earlier so I had a better chance at remission.  Being sero-negative Dr's would not Dx even though I had all of the other symptoms but a perceptive PCP Dx'd it and got me on a DMARD first now Ebrel.  Damage has slowed greatly but pain levels still very high with puffiness. I would guess that treatment depends on the doc and the person being treated.  Personally, I would go for aggressive treatment right off the bat.  I say that because they did not have these drugs when I was diagnosed so many years ago and I feel I would be in better shape if they did.  Also, without my mtx and humira....I would be in a wheelchair at this point in my life.  My 12 year old now has JRA and they will be treating her aggressively.  Sometimes you just have to be aggressive with this disease.  I used to be of the thinking to try the milder stuff first.  But after my daughter being diagnosed...no more.  Grab this beast by the horns and face it head on.  BUT please keep in mind this is only how I feel about it.  Thanks Bonny and Grammaskittles - Your opinions are worth a lot to me! There is, I think, a tendency (wrapped up in denial) to want to ease into treatment.  I'm trying to be level-headed about this.

All the latest research indicates that early aggressive treatment can put you into long term remission, plus prevent a lot of damage. Apparently the first two years are really important. Unfortunately, I wasn't diagnosed early also because of negative blood work. But when I was, I was started on MTX and a biological together immediately. I grabbed them both because I could barely walk.

The reason many doctors start you on MTX and a biological is because the biologicals are fast. If you combine MTX, plaquell, Sulfazine etc--all of those can take 3 months to start working. If the damage is happening three months can mean the difference between being able to pick up pots and pans while cooking and forever dropping things and not being able to pick up anything over 3 lbs-for the rest of your life.

MTX is first line because it works and works for more people for a longer amount of time than any other drug. I know it sounds scary but many many people are on it for years with no problems.

Some researchers believe there are two windows. 3 months is ideal and two years is still very good. Though every person is different. Some people might just have a year, while others 3 years. Its not like they are firm "anniversary" dates.

Bee

 

Some of the latest research has proven low doses of prednisone very often don't just reduce/eliminate the pain but also slow down the joint destruction caused by RA.  Guess we each need to decide what risks we are willing to take with the meds they prescribe, in spite of the fact they don't know what causes RA.  Take Care
I think it is terrible that three months is considered an important window and most of us are waiting at least two months for an appointment!!!!

Exactly, that is terrible. But that is a good point about prednesone. Perhaps, regular doctors should be encouraged to put patients on pred while waiting for a Rheumy.

There is a real shortage of Rheumies and apparently it is even worse for children. But when you think about it--if you were going to be a doctor--would you want to be one for a disease that a) no cure, b)involves a lot of pain, c) you can offer strong scary drugs or really expensive ones and the patients sometimes don't believe that they are seriously ill and don't want either.   It must be even worse for ped rheumys. The parents must be desperate to help their child (I would be) and also might not want to give them the strong scary drugs. A real heart breaker all the way around.

Yes, perhaps the focus should on the regular doctors to recognise it and start pred till they can see a doctor. If my regular doctor had believed me maybe I could had treatment sooner.

Bee

I've had this disease at least 30 years. I no longer believe in easing into treatment. I am suffering the consequences of that today - I'm pretty well crippled.

Slam this rotten disease in the head. Try to get your life back. Ruined joints are with you forever even if the RA goes away. 

When I explored, searched, found Wild Lingzhi, a #1 superb herb classified and recorded in a famous anxient Chinese medical book, I had discarded all meds/drugs almost 20 years ago.   

Also thru' searching for an answer, I used to cut out relevant reading materials and developed an awareness about the disease.  I totally dumped drugs for the good reason and I am lucky to be a FREE MAN FROM DRUGS AND THE DISEASE. I produce the following for your awareness:

In a congress of Rheumatology many years ago, a consultant physician and rheumatologist said that Methotrexate was a very potent, immuno-suppressive anti-inflammatory agent. Too big a dose, or over too long a time, could cause liver or lung disease. Some were put for a short time on fast-working and anti-inflammatory drugs called corticosteriods. Diabetes mellitus and high blood pressure were possible side-effects.

I read Dr. Bieler's book "Food is Your Best Medicine" opening message to the readers is: "As a practicing physician for over fifty years, I have reached three basic conclusions as to the cause and cure of disease. The first is that the primary cause of disease is not germs. Rather, disease is caused by a toxemia which results in cellular impairment and breakdown, thus paving the way for the multiplication and onslaught of germs. My second conclusion is that in almost all cases the use of drugs in treating patients is harmful. Drugs often cause serious side effects and sometimes even create new diseases.  The dubious benefits they afford the patient are at best temporary.  My third conclusion is that disease can be cured through the proper use of correct & healthy foods."

I enjoy the freedom of being trapped by meds nor imprisoned by the disease.

To get well is to reverse the disease: worst - worse - bad - good & freedom with herbs and correct natural foods.

I experienced taking drugs the situation is: good - bad - worse - worst.

Why lament? The choice is yours.

We learn good things from others and work hard to get well to be free from the disease and drugs harassment. 

 

Hi kokako88,

 I am interested to know what you did to cure your disease? explain in detail please if you can..

 

I feel I'm very lucky...even though I'm sero-negative my rheumy has been what I consider aggressive with my treatment.  Could be because even though I'm sero-negative I did have a lot of visible swelling. 

Within two months of my first appointment, I was on MTX.  After being on that about 10 months, I thought I was doing pretty well, but my rheumy convinced me I could be even better--I still had visible swelling--and some minor joint damage on x-rays.  Anyway, we added Enbrel to my mix (this was last September)--and I'm doing very well right now.  I'm not sure if I'd say I'm in remission, but I'm awful close.  I still have minor problems with my ankles if I've been on my feet for quite a few hours.  I'm almost able to do everything that I was able to do pre-RA--so I'm very happy with my treatment so far.

dordale

That is awesome dordale!  That makes me soooo happy to see treatment working for someone!  You are a great example to those struggling right now that it can get better.  It just takes time and sometimes playing with meds. 

I am happy with where I am at right now and working towards remission again.  I am nowhere near it...but I will keep on fighting for it.  I may never be the same as I was before last fall (family doc says no I won't be...being sick and the RA out of control took a really bad toll on my body), but I know there is still room for me to improve a little bit and that is what I will strive for.  

Joint damage is irreversible.  We never get good joints again after the damage is done and I personally prefer to not be in a wheelchair.  One day it may come to that...but for right now...I am grabbing that beast by the horns and giving it a good what for.   

i was just diagnosed two months ago when I had symptoms and have been on 15 mg of mtx/week plus 10 mg of pred daily.  I start the injectable mtx 20mg a week and planquil on monday. If that does not work, I will move to the enbrel.

I guess I am lucky as I caught this disease early and will sacrifice in order to go into remission

Zeekman, Aren't you afraid of Side effects? I was also dignosed couple of months back..But couldn't dare to take mtx. I am on Antibiotics.

Even though I have been seeing a rheumy every 10 wks for years (fibro), it still took "too long" to diagnose my RA.  From the time symptoms started and going through diagnostic tests and follow-up appts to narrow it down and then get me on meds, it took about 7 months.

I have been on Enbrel since January and oddly, my rhuemy didn't mention any other treatments.  In March, I wasn't seeing results and based on all I've read on the internet and in our communities (thank you all!), I asked him about adding mtx, or pred, or AP.  He added oral mtx (3x2.5 mg/wk, now 4x) and didn't say anything about the pred or AP.  I did see a little improvement a week or so ago, but it seems to be gone again (which is almost worse than no improvement at all).  At my last appt, my bloodwork showed reduced inflammation (CRP and sed), but I am having it again on Saturday and I'm curious to see if it's back up.

My rhuemy has been an excellent doctor, and yet it is still so frustrating that I am in serious trouble (round the clock Vicodin ES for my pain on top of all my other meds) and it is taking so long to get any kind of control.  I don't know how much long term damage has been done, but I know that nearly a year of this pain has been pretty traumatic.

Glowie....you have not done pred at all?  Ever??  I mean it sin't the most fun drug in the world to take but sometimes we need it.  I would seriously talk to your rheumy about that and why you are going so uncontrolled for so long.  Even with inflammation rates down....damage could still be happening.  Especially if you still have pain and swelling.  Time to think about some new combo of meds maybe?

Nope, no pred.  Ever.  And honestly, from all I hear, I haven't been too eager to ask for it.  But my last rheumy appt fell during my 2 weeks of "improvement" so there wasn't so much a question of changing...it seemed like the Enbrel/mtx combo was finally working.  Now, 2 weeks later, it's not looking that way anymore.

My next appt is in 2.5 weeks, so we'll see what's happening then, what's on my bloodwork from Saturday (including those special thyroid tests to check for Wilson's Thyroid), and whether or not pred is the way to go....or even switch biologics?

I was just diagnosed a couple months ago too...and I was started on 5mg Pred. and 400mg of Plaquenil. No true relief at this point....I see my rheumatologist May 18th, so I'll be curious what he says. I still think I'm kinda in denial. My pain isn't so bad I can't work....I can take care of my children...I keep thinking, "Maybe they were wrong, maybe it's just cuz I'm overweight and out of shape."
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