A person playing a whack-a-mole game where pills replace the mallet.

Choose Your Symptom

Or, pick your poison. Rheumatoid arthritis is a fun disease. It wreaks havoc on every part of our bodies. It provides a full access pass to the carnival of inflammation that affects everything from our joints to our bones to even our spleen, kidneys, lungs, and brain.

Treating a few RA symptoms

And, more often than not, we experience all the symptoms (fatigue, pain, stiffness, nausea, to name a few) at the same time. If one symptom goes, then one usually follows. If one visits, it's always accompanied by a friend. This three-ring-circus is closely connected and never broken.

In a perfect world, I would find a medication that keeps all these little demons at bay. Until then, I treat one or two symptoms at a time and hope there is something more to combat the other ones.

I have had to make a decision choosing to treat one symptom over another many times. Often, it feels like flipping a coin.

Treatment decisions with steroids

Probably, the first decision had to be with the Prednisone when I first started it. It took down my inflammation like nothing ever would/could. At the time (20 years old and completely healthy), I did not have any osteoarthritis.

Opting to control inflammation

If I remained on such a high dose, I would quickly lose bone mass so what to do: stop or lower the prednisone to a point that it was only controlling some of my symptoms, or continue on a higher dose and risk permanent bone loss? Ultimately, I lowered the dose a bit and opted to control my symptoms. I did develop osteoporosis and osteopenia down the line but the management of my symptoms well outweighed this risk (at least to me) and I have not once regretted this decision.

Tough decisions with DMARDs

Next came deciding my methotrexate dosage. This was as finicky a medication as prednisone.

Methotrexate

I was extremely sensitive to methotrexate, so there was a lot of trial-and-error in finding that sweet spot. I experienced severe fatigue to the point that I was bedridden. I was vomiting regularly and my RBC and iron counts began to decline.

Here’s the thing, though: methotrexate was pretty darn effective in controlling my symptoms. Where those side effects worth the good? Do we treat the nausea and energy concerns separately or just lower the dose and risk disease management? Ultimately, we chose the latter. What was the use of RA control when I couldn’t get out of bed or keep any food down? We lowered the methotrexate to the lowest possible dose.

Sulfasalazine

A few years later, we tried adding Sulfasalazine which gave me pretty severe nausea. So, we tried halving the dose and I took one pill every two days. I still experienced nausea, so my next option was to take a half pill every other day. I was still experiencing nausea. Should we add an anti-nausea pill and continue the medication?

I ended up stopping the medication because at half a tablet every other day, we were not going to see significant enough control and it wasn’t worth the constant stomach upset.

Which RA symptoms do I treat?

Those are very specific examples, and I sure have a lot more but I have to make these decisions every day. When I wake up flared, do I increase the prednisone (my go-to, LOL) or do I muddle through and take more pain medication? When I have sinus headaches or almost-infections (as I fondly call them), do I start a course of antibiotics, nip the infection in the bud, but have to stop my methotrexate that week? Or, do I let my body take care of itself, stay on all my medications but risk the infection and whatever comes with it down the line?

Sometimes it’s a toss-up. Treat one symptom and ignore the rest. Which symptom gets my attention today or tomorrow or even next week?

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