Question about tiers
The Rheumatologist that diagnosed me with seronegative RA said there were 3 tiers of medications. She was going to start me out with a rier two however after discussing it she started me out with tier one which was plaquenel (sp). That was 2 years ago.
Have any of you heard about these tiers? I am not asking for medication advice. My Rheumatologist and I will discuss that. I was curious as to an example of tier 2 meds.
My Rheumatologist said humira would be a 3 tier medication.
I do go to a different Rheumatologist in another week that I have seen 3-4 times through video.
My first Rheumatologist was great but retired. rx me with chronic myofascial pain syndrome and malagia. My second one got done as coming to my state from SC every 6 weeks was yoo much. She RX me with seronegative RA, small fiber neuropathy, polyneuropathy, and discovered I don't absorb vitamin D or B 12 like I should.so on supplements for that.
My new Rheumatologist who is 2 states away and comes up every 6 weeks for a week seem good so far. We have our first face to face in person in a couple weeks.
So I'm curious about the tiers and a bit about my journey.
Hi
. When it comes to RA the term tiers can get pretty complicated/confusing. What I mean by this is that it is often used in different ways. The most common is probably when used by insurance companies. They use tiers to describe levels of cost. Even then it is not consistent, with different companies using anywhere from 3 to 5 tiers.
Your doctor seems to be referring more to treatment levels (which can end up being similar to the tiers the insurance companies use). These can also vary. For example, if you look at this page from the Johns Hopkins Arthritis Center you will see three tiers, with biologics in the second tier and the third tier reserved for extreme measures for life-threatening manifestations, such as articular issues: https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment.
More generally, RA medications are grouped by their category, such as Non-steroidal anti-inflammatory drugs (NSAIDs) or Disease-modifying anti-rheumatic drugs (DMARDs). This article from our editorial team discusses the various medication types in these categories: https://rheumatoidarthritis.net/treatment/drugs-and-prescription-medications-for-ra (see also here for another example: https://nyulangone.org/conditions/rheumatoid-arthritis/treatments/medication-for-rheumatoid-arthritis).
Hopefully all of this hasn't confused you further. The short answer is to ask your rheumatologist what they mean by tiers and perhaps ask them to relate it back to categories of medications. Best, Richard (Team Member)Thank you so much. This was extremely helpful and easy to understand
