Rheumatoid arthritis management and medication
Good afternoon all, my partner was diagnosed with Rheumatoid arthritis age 27. He is now 31, has had all the usual Methotrexate, Hydroxychloroquine, but as it is progressing he is needing more and more steroid doses. He’s been told he’s only allowed two courses of steroids in a year, however in the past 6 months due to the severity he has had two normal doses, 1 injection and now currently on an aggressive dose again, unfortunately he did find himself in hospital 2 nights ago with sever chest pain and breathlessness and was said that it was down to steroids.
Rheumatology have since come back and did they’ve been successful in getting him funding for biological medication.
Is there anyone with good bad ugly stories of the bio medication as anything we read about it is horrific. All I want is for him to feel like he has a purpose, be able to do things that he wants to do and overall his mental health to improve as it has taken a real knock with the drastic change in his ability to do things.
Hi
. First. let me say that it is great that your partner has you advocating on his behalf. Your concerns about the switch in medications is certainly understandable. I can tell you that many community members do use biologics successfully, including my wife, Kelly Mack (a contributor here). Of course, each person is different and will respond differently to treatments, including between individual biologics. Kelly wrote here about switching medications and some of the stresses: https://rheumatoidarthritis.net/living/another-medication-change. She was writing about a change from one biologic to another, but many of the treatment concerns remain.
One thing of note about biologics is that they target specific areas of the immune system, as opposed to being blanket immunosuppressants, like methotrexate. For example, Enbrel and Humira are TNF inhibitors, while Actemra is an interlueken-6 inhibitor (see here for more information: https://rheumatoidarthritis.net/treatment/biologics).
You mention the impact of RA uncontrolled by treatment and the impact that these physical issues have on him mentally. This impact is certainly understandable and one of the best ways to counter it is through better RA control. Uncontrolled RA leads to further damage that can't be undone. Kelly was diagnosed at age two, 46 years ago - before modern treatments, with the damage to show for it. A conversation we have had more than once with her rheumatologist is about the hope that those diagnosed today won't have the same level of damage. One of the other contributors referred to the choice on treatment to be a risk to risk ratio. The risk of the potential issues from the treatment vs. the risk of damage from RA. Each person has to make the decisions for themselves based on personal circumstances and their case. That said, it sounds like the RA is taking toll on your partner. It is important, whatever medication decision is made, to work with the doctors to monitor progress and potential side effects. Hopefully others will chime in with their experiences and thoughts. Wishing you and your partner the best and please feel free to keep us posted on how things are going and to ask further questions. Richard (Team Member)Thankyou very much for your post, yes it is very daunting for him I think, and the fear of being hospitalised over common colds and chest infections etc is really playing on his mind being a dad of 4 little ones. But as I’ve said to him, he needs to be cruel to be kind, try the medication and see if it does work, and he has to put him as his priority not the children nor me, he has to focus on him and only him with support of others around him. I will definitely keep you in the loop with progress. Again thanks for your post. 😀
Hi
. Your very welcome. I get the concerns about infections, but I want to note that the reason that I mentioned the biologics not being blanket immunosuppressants is that those medications that are can actually be harder on the immune system. This is the reason the American College of Rheumatology recommended those on methotrexate or Rituxan have longer breaks for COVID vaccination. I can tell you that my wife, Kelly, had more infection issues on methotrexate than biologics. This, of course, is anecdotal, as each person can be different. His rheumatologist should be able to provide guidance. Best, Richard (Team Member)
