Rituxan - Our Other RA Caregiver

It’s been eight years now since Lisa was diagnosed with rheumatoid arthritis, and in that time, I’ve learned a thing or two about how to provide her care and support at home. Nevertheless I think it’s important to acknowledge the importance of her other caregiver – Rituxan – a medication that helps Lisa live an active and productive life.

Shortly after diagnosis, Lisa was initially prescribed three drugs – methotrexate, sulfasalazine, and hydroxychloroquine. The latter didn’t agree with her, so Lisa took the former two drugs for her first few years with RA. Things were going pretty well, but oddly enough, the fact that Lisa has two autoimmune diseases (RA and MS) eventually led to her discovery of Rituxan.

During 2008 and 2009, Lisa’s MS had become much more active and was progressing. She began looking for other treatment options. As she began researching medications that were being studied in MS, she learned that a specific ‘RA chemo drug’ might be useful in helping to control her MS. This was very exciting news.

Lisa initially spoke with her nurse at the neurologist’s office who confirmed that studies on Rituxan and relapsing MS had shown it to be effective. It might be an option for her. The nurse recommended that Lisa speak with her rheumatologist, which she did a month later, to discuss the possibility of switching. The key question for her rheumatologist – would her doctors be willing to let her try the medication to treat both of her diseases even though her RA seemed to be mostly under control with only occasional flare-ups?

The rheumatologist reacted favorably to Lisa’s inquiry, but wanted to speak directly with Lisa’s neurologist to discuss what was best for Lisa. Both doctors agreed that having Lisa switch to Rituxan might be an excellent option to tackle each disease. After concurring with the neurologist, Lisa’s rheumatologist contacted Lisa about their decision. I believe that Lisa said the rheumatologist's exact words were, “It’s a Go!!” when she called to report back on the discussion.

In November 2009, four years after her MS diagnosis and almost three years since her RA diagnosis, Lisa received her first round of Rituxan infusions. Shortly thereafter she noticed significant improvements in both her MS and RA. We were elated to see that Lisa responded so well to the medication. She was very fortunate.

Lisa’s rheumatologist had not prescribed Rituxan to many patients previously, so at the beginning she was concerned with how many infusions Lisa should receive over the long term. She recommended waiting until RA symptoms returned before scheduling the next round of treatment.

Lisa would wait to call the office until after the pain and swelling returned which seemed to happen about 7-8 months after each round of infusions. Once this pattern became consistently predictable, Lisa talked to her rheumatologist about scheduling infusions every six months, before the symptoms return. This is what we’ve been doing over the past three years and it seems to be working very well.

Lisa has now been on Rituxan for nearly six years and it continues to be effective. She generally does not experience significantly increased discomfort or dysfunction from either disease – definitely nothing like what she experienced prior to the RA diagnosis.

So while I may serve as Lisa’s personal caregiver, I would be remiss in not highlighting the important role that modern medicine plays in our lives. It is as critical a caregiver as I ever could be.

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