The Treatment Treadmill
When I was originally diagnosed with RA and began to consider, along with my care team, how to treat it, I had no idea that the choices would be nearly countless, change constantly, and be challenging to determine through the years of RA management.
Let’s talk about the countless choices first
I began to look at treatment options almost immediately after being diagnosed so that I could consult with my Rheumatologist with some degree of knowledge. What surprised me most was how many choices there were and that none really rose to the top as THE one to go with. Unlike some other chronic diseases that have specific treatment protocols to follow, RA is much more individualized and based on things like severity, the presence of the RA factor, medication tolerance, etc. With the advent of better studies and research, this area has exploded and we are the fortunate recipients. Nowadays you can choose from biologics, biosimilars, injectable or oral versions of medication delivery, physical therapy, acupuncture, chiropractic, massage therapy, and the list goes on. In fact, most of the time it is a unique combination, specific to you, that works best. That said, as a newly diagnosed RA patient I was, to say the least, overwhelmed! So, I simply took a breath and researched the choices and then took the information with me to my doctor’s appointment for discussion. Based on my own particular profile and after carefully reviewing them with my physician, we made some choices, both medication and otherwise.
RA treatment options change constantly
This brings me to my second point. The options change constantly! RA is not a simple disease to treat, with totally specified protocols. That’s the bad news. The good news is there are lots of options and thanks to the abundant and robust research on RA, those options change all the time, with new treatments in the hopper at any given time. That has not always been true. For decades there were a limited number of choices that ranged from gold treatments to aspirin, most of which are now archaic and no longer in the mix of choices. The change can be difficult to keep up with, but it is worth our time to do so. There are lots of ways to do that, ranging from more sophisticated medical journals to the more accessible options like the Health Union's Rheumatoid Arthritis.net site to other Arthritis journals. In addition, I challenge my Rheumatologist to share them with me when I have my appointments and I would suggest you do the same. Staying on top of the latest choices gives you time to consider what ones make sense for you because as we all know, our own RA profile is very specific to each of us.
But which treatment will work
Finally, the challenge of simply determining what treatment options will work over the years you are managing the disease is perhaps the most elusive. There really is no specific prescription for how best to accomplish this, but I will tell you that as time goes on, you will develop a higher degree of confidence in your own decision making when it comes to treatment choices. For instance, I now know after all of these years, that most of the medications I choose seem to have a shelf life. That is, after a period of time, I tend to develop a tolerance and they lose their effectiveness. This means I have to move on to something else. How long they work is not a finite number of years or predictable, so that is variable, but eventually that time catches up to me. By contrast, I have friends who have been on the same biologic for over a decade! Knowing this has made the reality of treatment options a little less stressful, if for no other reason than I will not be surprised. And given the chaotic nature of RA, anytime I can reduce the surprise element I am pleased.
Some treatment options seem to always be wise. For instance, managing flares in terms of rest, activity, etc. This is always a must and should be sorted out. How to keep moving, however small, is necessary and a key part of the treatments you need to embrace. There are more and they are numerous, so establishing them in consultation with your care team will make the treatment treadmill move at a pace that is perfect for you.
When was your last flare?