Sick Again

The people closest to me will often ask, “How’s your arthritis doing?” If I had osteoarthritis, the most common form of arthritis and generally caused by wear and tear, this would be a fairly straightforward question. I would just think about how much pain I was in and provide an answer.

However, I don’t have osteoarthritis. I have rheumatoid arthritis (RA), which is an autoimmune disease and, therefore, extremely complicated. RA, like osteoarthritis, definitely causes pain. However, it goes much further. It can cause extreme fatigue that makes getting through a day difficult. It can cause swelling that may not hurt, but is causing joint damage that will be very painful and may even require surgery down the road. RA can also impact muscles, ligaments, and organs. Furthermore, RA is an autoimmune condition, which leads to additional complications.

An increased rate of infection due to RA

People with RA are more prone to infections than those without chronic illness because our immune systems are misdirecting our “fire power,” targeting healthy joints and tissues instead of bacteria and viruses. In addition, many of the drugs used to treat RA are immunosuppressants, which render our immune systems less able to attack our joints, but also less able to fight infection.

For the past several months, I’ve been fortunate in terms of joint pain. Most days I’d rate it at a 2 or 3 on that ever-referenced 10-point pain scale. When I’ve had flares this year, they’ve been brief, only lasting a day or two. I’m very grateful for that. Yet, if I’m asked, “How’s your RA doing?” I can’t give a simple, “Pretty well, actually.” That’s because while my joint pain is tolerable, my rate of infections is problematic.

Sinus infections with RA

In the 17 years since my diagnosis, I’ve struggled with repeated infections. The most common are bronchitis, sinus infections, yeast infections, and cold sore outbreaks, with a smattering of colds, flus, strep, etc. A little over a year ago I had such an extreme sinus infection that I was willing to do anything my ENT recommended to avoid such severe illness in the future (while plagued with sinus infections, I’d had no idea just how serious they could become until struck by that one). Due to the severity of that infection and the frequency with which I had sinusitis (4-6 times per year), my ENT recommended a sinus procedure. However, he warned me that while the procedure typically has a 90-95% success rate, with my immune system issues he was only willing to predict a 50% chance of significant decrease in infections.

For the first nine months after the surgery, I was free of sinus infections. I still got sick far more often than my peers, but I was able avoid the secondary infections in my sinuses. However, I was then struck with four sinus infections in as many months. After my most recent infection, my allergist prescribed antibiotics with multiple refills, stating that the frequency and severity of my sinus infections necessitates ready access to the drugs. This is in addition to the steroids and antibiotics that go into my nasal rinses, as well as two prescription nasal sprays. I end up with quite a pharmacy bill for sinus treatment alone.

Complications from RA are frustrating

These repeated infections add to the frustrations living with rheumatoid arthritis entails. I have had to miss additional days of work, feeding worries that I’ll be perceived as a liability. I’ve missed social outings and events because I feel too cruddy to be anywhere but in bed. My medical expenses are a significant portion of my budget, rivaling my mortgage payment. There’s the uncertainty of never knowing when an infection or a flare will strike. And of course there’s the unpleasantness of feeling terrible.

Repeated infections take a toll on my life in many ways, yet it’s a symptom of RA and side effect of RA treatment that isn’t frequently discussed. When someone asks me how my RA is doing, my honest answer might be, “Not so great; I have an awful sinus infection.” I’m sure such a response would produce a look of confusion, but I know it’s all related.

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