When is it Time for a New Treatment Plan?
Since my diagnosis almost eight years ago, I’ve been on nine different biologics (with or without associated, secondary DMARDs). I’m not talking about temporarily going off a treatment because I’ve been sick or having surgery. I’ve had plenty of those. These were complete revamps of my medication plan.
I promise you, contemplating a treatment change really doesn’t get easier. You get used to being on a medication and thinking about an unknown drug can be scary. However, there are times when changing your treatment plan becomes advisable. These changes can mean adjusting the dosage of the current medication, changing to a different medication, adding another medication (even if temporarily), or discontinuing all or part of the treatment regimen.
Here are some circumstances that can prompt you and your rheumatologist to discuss a change:
- Your initial treatment is just that. As a general rule, doctors like to treat patients with the lowest effective dose of the mildest medication possible. This keeps the incidence of side effects (as well as prescription costs) low. So when you’re first diagnosed, your rheumatologist is likely to initially prescribe low dosages of one or more DMARDs such as methotrexate. It’s normal to wait up to three months to see if a drug is effective. If you’re still having pain and swelling your doctor may increase the dosage of the drug(s), add an additional drug, or switch you to a different medication.
- You are having serious side effects. Like most other drugs (if not all), medications used to treat RA and other inflammatory conditions have side effects. Very often these are a temporary situation and will ease once your body gets used to taking the drug. Some side effects can be offset. For example, if you have an injection site reaction, taking an antihistamine such as Benadryl before you take the injection can help prevent the reaction. You should always discuss any side effects with your doctor who can give you suggestions for controlling them or, if the side effects are serious enough, modify your treatment plan.
- The treatment plan is no longer working. It’s very discouraging to be on a treatment plan that is working and then have it stop being effective. This may never happen to you, but if it does, there are two main reasons this can occur. First, RA is a chronic disease and it changes over time. Your treatment plan needs to be modified to adapt. This might involve increasing the dosage of your drugs or adding another medication. The second reason is that your system may actually build antibodies to the drug – just like it does to germs and viruses. To your body, a drug is a “foreign invader” just like a disease and it will build defenses against it. If, for example, you are on one kind of biologic medication and become resistant to it, you might need to switch to another medication that works in a different manner.
- You cannot afford the medication. This is a sad reality for a lot of people. Even with the many patient assistance programs available, RA drugs can be very expensive and may prompt people to try less costly options. Sometimes when you change health insurance companies, some drugs may not be covered at all or may only be covered if other drugs have been tried and failed. This might cause you to change to a drug that is covered by your insurance.
- You achieve remission. This is, without a doubt, the absolutely best reason to change your treatment plan. While there is a lot of clinical discussion of the exact definition of “remission,” generally it’s considered very low to no disease activity over a period of time. When this occurs, your rheumatologist is likely to recommend changing your treatment plan to lower the amount of medication you take. This might entail reducing the dosage or discontinuing a secondary drug from your regimen.
Over the years I have, for a period of time, stopped taking my RA medications altogether. (Which has been, for me, a very bad idea.) However, I did so only after discussing this idea with my doctor. And a discussion with your doctor should always be the first step in any changes to your RA medications.
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