New to RA? Treat It, Please.
You think you might have rheumatoid disease (arthritis), but you’re not sure. You’re reluctant to bring it up with your doctor. You’re afraid she’ll think you’re imagining it, or exaggerating, or being a know-it-all because you googled—or all of the above. Or maybe you’re afraid you’re right and you do have it. What then?
Or maybe you recently received a diagnosis of RD, but you’re unsure about how—or even if—you should treat it. You’ve heard or read about the sobering side-effects of many RD drugs, and you’re worried about taking them. Given how serious some of them are, who wouldn’t be a little scared?
I’ll put this in the most respectful, yet urgent way I can: please stop hesitating. If you aren’t sure and haven’t pursued a diagnosis, please don’t wait any longer. See your doctor. And if you do have RD, then please treat it.
Rheumatoid disease is deadly serious. It’s not your garden-variety, older-person’s arthritis (though osteoarthritis is no picnic, either). The main difference between the two? RD can affect your entire body, not just your joints.
RD is a systemic autoimmune disease. It causes the body’s immune system to attack, damage, and destroy its own tissues as if they were foreign invaders, like viruses or bacteria. No one really knows what causes RD, but scientists suspect genetics, environment, and other factors, including smoking, may trigger it.
RD makes the immune system attack and inflame the synovial tissues. In the joints—the part of the body most commonly affected—these tissues form the joint capsule, a tough-but-soft, very flexible cushion that lies between the bones that form the joints themselves.
But there are synovial tissues in the linings of the heart, the lungs, the kidneys, the eyes and even the veins, too. And that’s why I called RD not only serious, but deadly serious. When RD inflames and swells the lining of the heart, its function may be impaired. Same with the linings of the lungs and the kidneys. In the eyes, it can lead to impaired vision, even blindness. And RD-inflamed veins can cause serious or even deadly circulatory problems.
RD seems to mostly prefer the joints, though. It causes swelling, pain, and in some people, it erodes and destroys the joints, causing disability. It also inflames the surrounding tissues that support the joints: the shock-absorbing cartilage, the tendons and ligaments that connect muscle to bone, and even the muscles themselves.
RD inflammation causes other symptoms, as well: low-grade fevers, fatigue, and a flu-like malaise that is often simply overwhelming.
Finally, RD is a progressive disease: it may get worse over time. And although it may also go into remission (become relatively quiet and inactive) for days, weeks, or in some cases, even years, it never actually goes away. RD is incurable.
Treating RD with Drugs
Incurable is a scary word, so tuck it away in the back of your mind. Don’t forget it, but don’t think about it all the time. Incurable isn’t always untreatable.
Fortunately, there are many treatments today for rheumatoid disease. Many of them work exceedingly well for many people. But some of those same treatments don’t work for many others. It’s one of the most frustrating aspects of the disease: it’s hard to pin it down. Its symptoms and intensity vary from person to person. The drug that works for you might not work for me, and vice versa. And a drug might work for a while, then stop.
RD drugs include a wide variety of NSAIDS (non-steroidal anti-inflammatory drugs), including meloxicam, naproxen, and ibuprofen. These drugs work to decrease inflammation in the body and, as they do, decrease the pain and other problems it can cause.
Other drugs for RD include the DMARDs (disease-modifying anti-rheumatic drugs) like methotrexate, sulfasalazine, leflunomide, and hydroxychloroquine. These work to slow the progression of the disease itself, helping to decrease pain and joint destruction over time.
The biggest and newest guns in the RD-drug world are the biologics, drugs made with biological materials such as certain enzymes, proteins, and antibodies. They include adalimumab, etanercept, and rituximab, among others. Some target specific biological processes within the synovial tissues, others specific antigens that cause the immune system to react and attack itself.
Each of these drugs has a role to play in treating rheumatoid disease. And each of them has side-effects that range from mild, non-threatening, and transitory to downright dangerous. The thing is, not everyone who takes a drug experiences side-effects. A small number of people may experience one, others several, and many more no side-effects at all.
Is there a risk to taking drugs for RD? Yes. Can they hurt you? Maybe, but probably not. The thing to do is to learn all you can about the drug in question. Talk to your rheumatologist about it. Ask lots of questions. Google the drug and read about it. Then weigh the minor risk of possible side-effects against the serious, real risk of the disease itself. Does taking the drug offer a good chance of really slowing—or even halting—its progression? Might the drug help relieve your pain and other symptoms so you can live a more normal life?
These are the questions to ask yourself and your doctor. I take an NSAID, three DMARDs (triple therapy), and a biologic drug to treat my RD, along with vitamins and calcium. I’ve taken some of those drugs for five years or more. Over the years, I've had to stop taking some of the drugs for RD I've tried because the side-effects were intolerable to me. Others I’ve tried didn’t work for me. You might tolerate those same drugs very well--and they might work very well for you, too.
A side-effect of one of my RD drugs is hair loss. It's caused me to very slowly lose my straight-as-a-string hair--but not very much at a time, and not all at once, thank goodness! The hair that's grown back in its place is curly. So, along with helping to keep my RD under control, that particular drug has given me the “naturally” curly hair I always wished for!
How you decide to treat your RD is ultimately up to you. But please, make sure whichever decision you make is an informed decision. Rheumatoid disease is nothing to take lightly. It’s serious—and in some cases, it's deadly.
On a scale of 1(low) to 5(high), how difficult is it for you to talk about having RA?