I was diagnosed with RA in mid-2008. Like many people, my rheumatologist began my treatment plan with methotrexate along with an NSAID and pain relievers. In the six years since then, I’ve moved forward to my sixth biologic supplemented with a disease-modifying anti-arthritis drug (DMARD) and an NSAID. The good news is that I’m doing well on this latest cocktail and I am hopeful that drug changes are behind me for a while.
But how do you know when it’s time to change?
You must be very honest with yourself and your rheumatologist about what is working and what isn’t. There are various options that could be available. Including a change from one primary drug to another, the change might be a different dosage of the drug you’re taking now – if you’re tolerating the drug well and you just need “a bit more”. Additionally, if you’re on a monotherapy (a single drug regimen), your rheumatologist might recommend an additional, different type of drug to complement what you’re currently taking. In my case, I’m taking a biologic and a DMARD.
Ask yourself these questions and discuss them with your rheumatologist:
- Why do you feel the drug is not working? What symptoms are you experiencing and how bad are they? Are you having the occasional morning stiffness or are you having frequent, debilitating flares?
- Have you been on your current drugs long enough for them to be beneficial? Some drugs can take up to three or four months to reach full therapeutic effectiveness. If you’ve only been on a drug a month or so, you should probably be patient about asking for a change. However, your rheumatologist might prescribe a supplemental therapy, such as a low dose of prednisone, to help your symptoms until your primary drug has time to work. So while it may not be time for a full course change, it may be time for some additional help.
- What is your tolerance/preference for the drug delivery system? For example, many biologics are self-administered by injection (that is, you have to give yourself shots). Other biologics are administered by IV infusion. You need to discuss these issues with your rheumatologist when making a drug decision.
Changing to a new drug can be scary. Starting my first biologic was nerve-wracking for me. Not only was it a strong drug with potentially serious side effects, I had to give myself injections. But I reached a comfort level with it. I knew what to expect with the drug and had gotten used to the injection routine. Switching to a new drug that had a different dosing schedule and might have different side effects was frightening. However, you must remember that taking a drug that isn’t working well is futile. You aren’t protecting yourself from RA. It is much better to change your drug therapy and find something that is effective.
The best course of action is to be open and honest with your rheumatologist. The best course of treatment, whether drugs or other forms of therapy, always stems from that.
When was your last flare?