It's the Engine, Not the Caboose
It's the engine, not the caboose, that kills you is actually a saying that’s used in Alcoholics Anonymous as a warning against taking that first drink – which can lead to the second, and third and so on. It was also used by Jack Cush, MD, a preeminent rheumatologist in a recent article. One of the themes of the article is that in focusing on the potential side effects of treatment, we forget that the greatest health risk is the disease itself.
This struck me as fairly profound because as much as I read about patients being concerned about the possible downside of treatment plans, I don’t read nearly as much about the downside of not treating the disease.
There is no question that having an RA diagnosis and starting a long-term treatment plan can be life changing. Moving to a biologic or even changing to a different biologic drug can be stressful or even frightening. Anyone who has read the patient information (including those discussing side effects) probably feels very justified in being cautious. Even a more natural-based treatment plan based on diet and supplements can be daunting and have potential unwanted impacts.
But there are a couple of things to consider.
The first is that general patient information gives you the possible side effects. However, most patient-level information doesn’t disclose what the actual chances are that you might develop them. Serious incidents are actually rare events and may only occur about once in every 1,000 patients. At that rate, these drugs are fairly safe and are, in fact, much safer than having uncontrolled inflammation in your body. That’s the second and most important thing to consider.
Common lab tests for RA patients check for inflammation and may include things like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). These tests measure inflammation not just in your joints, but throughout your body and they’re the same tests used to evaluate risk factors for things like heart disease and stroke.
The fact is that while its effects are most frequently seen in our joints, RA is a systemic disease. This means that it extends throughout our bodies and can cause inflammation anywhere. According to Dr. Cush and other newsworthy experts, when inflammation becomes chronic it can damage heart valves and brain cells (think heart attack and atherosclerosis), trigger strokes, and promote resistance to insulin, which can lead to diabetes. Inflammation also is associated with the development of cancer. Inflammation may not have been proven to cause all of these issues, but inflammation is unquestionably a common factor.
I’m the first to admit that having RA is a scary thing with major consequences. Thanks to RA I’ve had a lot of surgery including three joint replacements and two spinal fusions and had to retire early from a career I loved.
However, failure to control the inflammation that comes along with RA can have even more serious consequences. It’s important that you and your health care team determine an effective plan that works for you. Remember, it’s the disease, not the treatment plan that’s the enemy.
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