My Pathway to RA Combination Therapy
Although I’ve had rheumatoid arthritis (RA) symptoms for most of my life, I’ve only been treated for it since my official diagnosis five years ago.
When I was finally diagnosed correctly with RA, I was already living with Crohn’s disease, another autoimmune disease that affects the gastrointestinal tract.
A biologic to treat Crohn's
I had tried a variety of oral medications to manage my Crohn’s but had ended up receiving a gut-specific biologic (Entyvio) via infusion every 8 weeks.
Unfortunately, this medication wouldn’t be able to treat my RA too, and it couldn’t be combined with another systemic medication either. This meant I was required to switch meds, and ideally needed to find something that could manage both my Crohn’s disease and my rheumatoid arthritis.
Trying Humira for Crohn's and RA
My rheumatologist recommended a switch to Humira, a biologic with a bi-weekly self-injection, that could theoretically help both diseases.
While waiting for insurance approval, I was placed on steroids to help with my body’s out-of-control inflammation and pain. I knew that steroids were only a short-term option and they came with a slew of side effects I was less than excited for, but I was hopeful for (and then, thankful for) some much-needed relief.
I started Humira as soon as my specialty pharmacy could have it delivered to my house, but I ended up having an adverse side effect from the medication.
A recommendation of Remicade
After six weeks, it was discontinued, with the replacement recommendation of Remicade, another infusion-based biologic.
I was so optimistic about this recommendation. I knew many patients in both the Crohn's and RA communities who had found great success and even disease remission on Remicade.
The challenge? Bureaucracy.
My insurance took 42 days to approve this medication switch. In the interim, I went into full flare mode. My RA was out of control. I was in so much physical pain I could barely move.
Grateful for the relief brought by Remicade
As such, when I finally was able to begin receiving Remicade infusions, it took some time for my symptoms to reduce. They didn't disappear overnight, but when I finally started feeling better, stronger, more like myself, I cried with gratitude.
I started Remicade in March 2017 at 5mg/kg every 8 weeks. But, the dose and frequency had to be changed periodically due to my Crohn's disease activity. By December of that same year, I was receiving 10mg/kg every 6 weeks - an amount that put both of my autoimmune diseases into remission.
Combination therapy with another DMARD
Two months later, routine blood work showed that I'd begun to build antibodies to Remicade, my miracle medication.
My doctors conferred, and their suggestion was to add on a conventional disease-modifying anti-rheumatic drug (cDMARD) called Azathioprine (Imuran).
One study has shown that Imuran may prevent an immune response to biologics like Remicade and can work long term in conjunction with a biologic. However, more research is needed. 1
Keeping up with regular check-ins
I've now been on this combination therapy for several years and, knock on wood, it has kept my symptoms managed and my antibody levels consistent. Meaning, I am safely able to stay on both medications.
Because of my history, it's imperative that I attend regular check-ins with my physicians and undergo routine labs to monitor my medication response. But I'll take that over being in a full-out flare any day.
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