The Day My Meds Didn’t Work

My biologic, Orencia, hasn’t been working at full capacity for many months now. I know this because, at the beginning, I could feel a marked difference in my symptoms the weekend after my monthly Friday infusions. Now, I feel no difference. My fatigue is out of control and, while the pain and stiffness are not terrible, I see quite a bit of swelling in my fingers by the end of the day.

Over the past few months, my rheumatologist and I discussed switching my biologic but we knew I would feel way worse while we waited for any new medication to work (that dreaded three-month slump). I felt okay; not great, but I was managing my normal life without my rheumatoid arthritis getting in the way.

When my biologic stopped working

But, this past November, my infusion didn’t work. I actually flared-up the day afterward, which has never happened before. I didn’t feel any better for almost a week and, even though everything is manageable, my tolerance for physical activity has diminished quickly. I cannot type or sit for as long, my joints are visibly swollen, and stairs are my new nemesis.

Of course, there could be a stress element to this month that was not there before. My second cat, Sunsilk, passed away a couple of days before my infusion and that grief could have negated the effectiveness of the biologic.

Orencia had been losing effectiveness over time

That being said, my doctor and I have noted that Orencia was losing effectiveness for quite some time before November. And, what was weird about this entire experience was that none of my other meds corrected the flare. When I am in a flare, I usually bump up the prednisone and, depending on the severity, I might also increase my methotrexate. Don’t worry - this has all been discussed with my doctor as part of my flare-action plan. And, if needed, I will increase the pain medications.

But, none of that worked. My diet has not changed; my sleep schedule has not changed. In theory, changing my medications should have worked.

So, I guess I have to consider that my meds are no longer working. This is not unheard of, as many RA patients experience a plateau with their medication efficacy. And, this has definitely happened to me before.

This has happened before

In 2005, when my dog, Saachi, passed away, every single one of my medications quit on me. I was in such a bad flare, it felt like I was not taking any medications at all. I was dealing with an extreme. My doctor and I switched gears completely and tried different biologics (none of which worked). Ultimately, we let the Orencia fully flush from my system before returning to it.

This current flare feels nothing like that and I am still managing life without only a little degree of difficulty however, I wonder if my body is going down the same path as before.

Signaling a medication change?

Only a few months ago, I was marveling at the fact that I have not changed medications (with the exception of dosages) for nearly five years! For me, that is a freaking record!

So, maybe I’m just coming due for my plateau, which signals a change in medications. Maybe, it’s just that time of...life? Medication cycle? Management time? I don’t know what to call it, but I imagine you know what I am talking about!

But, before I go running to my doctor yelling “HELP!” I want to see how this next infusion goes. One month could just be a fluke and maybe after my next infusion (in just a few days), I might feel better?

We’ll see.

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