Woman is daydreaming of the perfect medication, labeled with a smiling star. In reality, she is rolling the dice and unsure of the outcome.

RA Daydreams: Drug Efficacy and Side Effects Predictor

Living with rheumatoid arthritis can feel like a nightmare, which sometimes leads me to daydream about things that would make this journey a little easier. 

If I had to describe rheumatoid arthritis/rheumatoid disease (RA/RD) with a single word, it would be unpredictable. For me, this condition often involves inflammation, sometimes fatigue, and always some level of pain.

RA's unpredictability applies to a lot of things

Yet the constant among all the varying symptoms is that I never know when they will flare up and which one will be the most pronounced.

This unpredictability extends to all things related to RA/RD, as my susceptibility to infections, work schedule, social calendar, mental alertness, ability to sleep, clumsiness, articulateness, and physical stamina all fluctuate with this disease. (Readers, if you can think of other areas of your life that RA/RD impacts, please share in the comments.) I never know from day-to-day, and sometimes even hour-to-hour, how active my disease activity will be, and how it will impact my life.

Finding RA medications that bring relief

Unfortunately, RA/RD can be just as unpredictable when it comes to treatment options. When I was diagnosed in 2000, medications to treat RA/RD were limited to corticosteroids, a few NSAIDs, some DMARDs, and two biologic drugs. While that may seem like a lot of options, the efficacy of these drugs varies greatly from individual to individual.

In this online community, I have read countless threads where one person says a drug has decreased their symptoms significantly while another says the same medicine did nothing for them. When my sister was diagnosed with RA/RD a few years after I was, we discovered we reacted very differently to drugs even though we had the same disease and the same genes. A medication that worked great for me would be ineffective for her, and vice versa. Therefore, it can take a lot of trial and error in order to find a drug/drug combination that helps.

What will the side effects be?

On top of the unpredictability of drug efficacy, it is also impossible to foretell whether a drug will cause side effects for an individual.

While some side effects are more common to medication than others, it seems that some people tolerate certain drugs really well while others experience severe and/or numerous side effects. When I was having severe side effects that led my rheumatologist to take me off a medication, he said, “We’re trying to improve your quality of life, and if the side effects are as bad as the symptoms then your quality of life hasn’t improved.”

The trial-and-error approach for trying medications

The good news is that in 2020 there is a huge variety of drug treatments available for RA/RD. Unlike when I was diagnosed 20 years ago, now when a drug is ineffective or causes problematic side effects, there are many other options to try.

The bad news is that this can involve a very long period of trial-and-error, as many drugs have to be in one’s system for weeks or months to take effect. All the while during this “wait and see” phase, RA/RD symptoms are wreaking havoc on one’s quality of life.

A drug efficacy and side effects detector

This is where my imagination starts running wild. Wouldn’t it be wonderful if there were a detector that could tell us immediately how our bodies will react to a drug? Before the painful weeks/months of waiting (and hoping) for a drug to kick in, this dream detector could tell us if, in fact, the medication will be effective.

Rather than trying four different drugs over the course of a painful year of inflammation and fatigue, we could sit with the doctor for a few minutes while she went through a process of checking medications with our individual systems until she found one that would be effective.

What are the specific side effects?

The dream invention wouldn’t stop there. Next, the doctor could use the detector to predict whether the drug would cause side effects and, if side effects were indicated, this technology would identify the specific side effect and its severity. Tolerating mild side effects may be worth a significant reduction in RA/RD symptoms, while moderate to severe side effects may not.

It would be wonderful to know ahead of time how one’s body will react to a drug before spending a day vomiting or receiving labwork indicating organ damage. Severe side effects could be avoided altogether if this technology were real.

It's all an RA daydream

Unfortunately, an efficacy and side effects predictor is still a daydream. In its absence, we continue to be called upon to put the “patience” into “patients,” waiting to see how our bodies will tolerate a change in our pharmaceutical treatment, and then waiting even longer to discover whether the drug will actually bring us any relief.

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