Treating rheumatoid arthritis and other autoimmune diseases is a game of Whack-A-Mole. When you finally find something that works, another issue pops up, and then you have to treat that. It’s a constant stream of secondary illnesses and co-morbidities. Finally, just when you think you’ve reached an almost unrecognizable form of equilibrium, the medicine that was working suddenly decides to not. Today, we’re gonna explore the exciting world of treating RA.
What does autoimmune mean anyway?
Autoimmune illness is unlike any other disease out there. The name says it all – auto+immune. And no, it doesn’t mean we’re allergic to cars. It means our own bodies are attacking us. I mean literally attacking: not like my body started a Twitter war with Kanye West and now his followers are after me.
In the case of rheumatoid arthritis, it’s joints; but, there are different autoimmune illnesses for pretty much every single part of the body. Bowel, nerves, eyes, joints...the list goes on and on. But, we all have one thing in common – it’s our own immune system that has decided that those parts of our body don’t really fit into its current paradigm, brah. So, it just starts to eliminate them – always in the most painful and destructive way possible.
Treating autoimmune conditions like RA is difficult
Medicine has always struggled to treat diseases that don’t fall into the “foreign invader trying to take over” category, and RA is no exception. I mean, I get it - it’s the equivalent of playing “one of these things does not belong” and trying to decipher one of those 3d stereographic images (I’m relaxing my freakin’ eyes already). In medical terms, it’s easy to spot something that doesn’t belong in the body. But when everything that’s there belongs there, how do you identify and stop the issue? Well, for many years we couldn’t and we only treated the symptoms, and still kind of do.
My experience with various RA treatments
When I came down with RA at age nine, there were not many medicines to choose from. In fact, there wasn’t even really that much known about what was called juvenile rheumatoid arthritis at the time. My mom would go to the library, which is like Wikipedia on paper, and read everything should could about the disease. Even so, we found only two or three doctors that even knew what RA was, much less knew what to do about it, and all were in New York City.
NSAIDs and gold salts
Those doctors laid out the current treatment options before us, and it was as bleak as the menu at Chipotle (before the queso). At first, I tried using NSAIDs to control the inflammation, which were pretty much just high-powered aspirin. After they discovered high doses of aspirin caused Reye’s Syndrome, it was on to gold salts. This fun medication was a weekly injection that didn’t add bling but contained chemical “salts” that were thought to help RA. Even today, they still don’t how exactly how gold salts inhibited RA. But because it didn’t work for me, I stopped.
Trying steroids like prednisone
That was when I started taking steroids, back then a “miracle drug” if there ever was one. Unfortunately, the side effects of prednisone were even more numerous than Instagram models who are #blessed, and I had to move on yet again. This movie played countless times, over and over. And when I finally ate all the pharmaceutical popcorn in my kiddie-pool sized tub (I got a small), none of the medicines did anything but provide a modicum of relief. Looking back, I shouldn’t be surprised since I was really only treating the symptoms, not the cause. Then biologics came along.
Oh, biologics! The holy grail of RA, they are going to change the game! I want to marry biologics! Biologics, have my baby! RA will be a thing of the past and patients will be running marathons and BASE jumping until their parachutes don’t open! Yes, biologics: the drugs that were going to cure everything and make autoimmune diseases harder to find than real milk in a hipster coffee shop.
Well, as you’ve probably already guessed, it didn’t quite work out that way. Biologics turned out to be yet another half-measure for me and many other RA sufferers. It helped some, sure. But most of us were stuck back in the same merry-go-round of “new drug, some relief for a while, stops working, next drug”, and that jerk in front of us keeps grabbing all the brass rings. It was a heartbreaking let down, but it shouldn’t have been a surprise. Autoimmune is a custom-made, couture, designer disease; no off-the-shelf remedy is gonna work.
And then there are RA comorbidities
So, many of us are left like me, where we fight the battles we can and suffer through the rest. The drugs out there do provide some relief, and really lucky individuals find a drug that works forever (I heard a rumor about some guy’s roommate’s cousin’s mother). Unfortunately, the vast majority of RA patients have pain and fatigue on a daily basis still, and deal with co-morbidities.
Co-morbidities! I mean, look at that word – it has “morbid” in it! Also, “co!” Admittedly less scary than “morbid,” but still! The only time I want the word “morbid” used to describe anything having to do with me is when I die morbidly obese because I bought a Scrooge McDuck money bin filled with KFC. Extra crispy. It’s a fact of life with RA, co-morbidities, secondary conditions that arise because of the disease.
Comorbidities that I've lived through
I’ve had heart attacks, lung issues, joint replacements, pneumonia with an awesome resulting c. diff infection that almost killed me twice, high blood pressure, ED issues (don’t tell anyone), hmmm.. what else, oh, duh! Cancer, how could I forget? Ha, ha, that’s right. Pesky lymphoma. Anyway, that’s just in the last ten years. All of these are directly related to my RA because the inflammation the disease causes is as bad for you as prolonged smoking and drinking, and RA doesn’t make you look half as cool as those things do. Even worse, in some cases, it’s the medication that causes issues, not just the disease. You know that phrase “the cure is worse than the disease”? Well, I’m convinced whoever coined it had RA.
After thirty-some-odd years of disease, I think I can make a convincing case for “treatment” and “RA” being antonyms. You sit in bed at night sometimes and wonder “why the hell am I even doing this?” It’s always a trade-off with this God-forsaken illness, and the choices are never good – do I want to ride this bike with no seat, or do I want to eat this Chinese food that’s been sitting in my fridge for a week? Ugh. I think I’ll go play whack-a-mole instead.
Check-in: As we start a new year, how are you feeling?