A person in pain crouched into a ball stuck inside a floating hourglass.

The Three-Month Slump

If you have a rheumatoid arthritis diagnosis in place and you have been on any of the medications available for it, then you may have experienced the “panic” when your meds stop working.

Over the last ten years, I tried almost all the medications available (with the exception of Rituxan and Remicade). Given my medical history, my rheumatologist didn't believe I would react well to those medications.

The dreaded three-month wait

I was lucky that my condition was caught and treated early. I experienced flares but my symptoms were well managed because of a fantastic and loving doctor. However, that didn’t mean I could escape the dreaded time frame of all these medications.

You may know what I mean. The three-month mark. We must wait three months to see if some medications (with exceptions, of course) will work for us. That’s an entire summer vacation worth of time!

That’s three months of excruciating symptoms that we have to handle some other way. That’s three months of disease activity that could damage our joints permanently. And, that’s three months of sitting and waiting for who knows what.

Waiting for RA medications to work

The first few years after my diagnosis were understandably tough. I was trying a host of different medications and I had to wait for results.

Stopping medications before starting a new one

This slump is especially difficult between medications because you must stop the current biologic to start a new one. Otherwise, you might as well put a deposit on a coffin right now because you are destroying whatever is left of your immune system.

Increased RA symptoms during transition

So, while you wait patiently for the new medication to work, the other one is fading from your system. This means that there will be a period where your symptoms will rear their ugly heads and cause a flare. Hopefully, the flare is manageable, enough, but at least, in my experience, it’s enough to cause disruptions in daily life.

I felt this terrible transition when the Orencia plateaued after years on it. I don’t remember what I tried next, but those months were NOT fun. Work, play, and everything in between suffered and there was just nothing to do about it. I just had to deal.

I tried a bunch of medications, Xeljanz and Arava to name a few, and none of them worked. But, thankfully, by that time, the Orencia had fully flushed out of my system. I restarted it and its efficacy returned.

Deciding not to switch RA medications

Unfortunately, now, it has plateaued again but my rheumatologist and I are extremely hesitant to switch medications. There are a few reasons for it. First, we’ve tried almost everything and I haven’t responded well to them.

Second, I’m doing pretty well, given the circumstance and if I go off the Orencia, I will certainly flare. Neither of us wants me to chance feeling completely worse with no out.

Third, the medications on the market are quite similar to each other and we think I will respond the same to the ones I have not yet tried.

Waiting three months is a long time

When I felt crummy, I definitely felt that “OMG, do I have to switch my meds again??” because I did not want to go through that dreaded slump. The big question was, “Was it worth being down for that long?" That is one-fourth of the year that I potentially cannot get anything done! I am not doing SO poorly that I think I need to change medications.

The three-month drop of activity is just not worth it right now, so I will continue to muddle along and hope that the Orencia doesn’t cut out completely.

I may have to change in the future, but hopefully not! Because, I’m in a pretty good place...just not a great one.

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