When Do You Throw in the Treatment Towel?

By Janeil Whitworth

2 min read

At the start of my RA journey, I was unaware of how many different types of treatments were available to treat the pain, inflammation, and overactivity of the immune system.

NSAIDs, DMARDs, biologics, etc., are all now a part of my RA verbiage and awareness as I have slowly made my way through the different treatment options. Some treatments have worked better than others, while there are even more that I haven’t been able to try as a young mom with a recent pregnancy and then a nursing infant. There are a couple of options that I know I could try in the future, but they may not be the best fit for my current lifestyle. A different medication for a different time, possibly.

What is our goal with treatment?

Bottom line: why does it have to be so complicated?

It leads me to wonder, what is your goal with treatment? What do others consider a “good” treatment? When do you decide to throw in the towel and try something else?

This may be different for each person, but my expectation of living with RA is understanding that I will not be pain-free 100% of the time. I think a more realistic goal is to remain in remission with periodic flares that lessen over time and are quickly controlled and managed until re-entering remission once again.

Achieving remission is a lofty goal for some

According to the American College of Rheumatology, remission criteria is achieving the following for at least 2 consecutive months:¹

No fatigue
No joint pain
No joint tenderness of swelling on motion
No soft tissue swelling in joints or tendon sheaths
Erythrocyte sedimentation rate ≤30 mm/h for women and ≤ 20mm/h for men

Is it just me, or does that seem like a lofty goal? By definition, I am not in remission, nor have I been in the last year. Truthfully, it’s frustrating to think of my disease activity in terms of that criteria. My own goal of treatment focuses more on quality of life vs. pain balance. I want my treatment to maximize my quality of life while minimizing my pain. In short, can I do the things I want to do with the current level of pain I am experiencing? No? Time for a new treatment.

How do you decide when to start a new treatment?

You can probably guess I am writing this particular article because I am not completely satisfied with my current RA treatment. After trying various NSAIDs, steroids, an SSNRI for pain, DMARDs, and finally, a biologic, I’m starting to wonder what the right treatment for me is.

I started Cimzia at the beginning of August. After completing the loading dose series, I am not on the maintenance injections. I have had some improvement in my symptoms, but not to the extent I expected. I feel like I am giving the medications enough time to work and take full effect, however, I still have pain that I think could be treated. Do you wait weeks, months, or years to determine if a treatment is working? When do you throw in the treatment towel in an attempt to try something else?

What is your experience with trying different medications? Share your thoughts below!

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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KillerQueen Member
I would also like to know the answer to this question. Have just started a biological and wondering how long I should give it?
L rick Phillips Moderator & Contributor
I usually give it at least six months. Now to be fair I talk to my about what is next each time I see him. While we talk about it, I really start talking about it when I get to the six month mark.
Jo Johnson Moderator & Contributor
<inline-mention username="Janeil Whitworth" user-id="3178061"/> such a well written post addressing the questions so many of us have! I wish you luck with the Cimzia. I’ve trialed several biologics and agree with Rick that 6 months is a typical measuring point. It can vary with some meds; hopefully your Rheum could help with that expectation. It is truly one of the most frustrating aspects of RD treatment! Trial DMARDs, Order Biologic. Wait for Pre-Auth. Start new med. Wait 3-6 months to see if it works and hope you don’t have to start all over again! Can be an 6+ month cycle. I have actually been waiting over a week to schedule my next infusion. The clinic has it in their Pre-Authorization queue - even though I confirmed with my insurance company 4 days ago that PreAuth is not required!! (It’s a Bio-similar) The drug I’m on is best evaluated after 2 six month cycles. 🤞🏻 I start my second cycle next week. Jo
Richard Faust Community Admin
Hi <inline-mention username="Janeil Whitworth" user-id="3178061"/>. When I read the title I immediately wanted to simply say "never" and follow it up with a great story about how Kelly found a treatment that brought her inflammation numbers into the normal range after over 40 years. Then I realized you were asking about throwing in the towel on a particular treatment ... never mind, shift gears, give me a second (although if you ever want a good rant on never giving up I got you). Ahh, the when to make the change question. Kelly actually wrote a piece on this (see: <a href='https://rheumatoidarthritis.net/living/when-to-change-medications' target='_blank'>https://rheumatoidarthritis.net/living/when-to-change-medications</a>). The big thing I think you touched on was goals versus actual impact. Then there is some aspects of individual reality that have to be addressed. Make sure the goals are realistic. Kelly is never going to eliminate pain, there is just too much existing damage, but better control and limiting inflammation to stop further damage is great place for her. For you it is something different. Also, I can tell you that for Kelly sometimes getting close to the goal is enough (note: she's recovering from a shoulder replacement right now or basically this would be coming from her). Of course, that all goes out the window if the side effects are just too great. The flip side is that one can put up with some side effects if the drug is a disease game changer. And finally, as Rick said, is time. You don't want to be changing meds willy nilly (what does that even mean, someday I need to look up the derivation), but if the drug kicks in and isn't doing the job or is like taking tic tacs without the added benefit of fresh breath then one needs to pull the plug. That said, each drug has an expected time by which you should start to feel something. All this is a real long-winded way of saying you basically got this and sometimes it just helps to hear it from someone else. Best, Richard (RheumatoidArthritis.net Team)
1. MommaSwain01 Member
 <inline-mention username="Richard Faust" user-id="3227544"/> , my mom had RA from 12 years old. I was diagnosed at 33. I’m 53 now. I have Latent TB, I was on black list antibiotics for 2 years and it’s still active. I’m in pain management because I can’t take biological medications or infusions. So I only get blood work and knee replacements. Do you have any ideas? Also I work with the Philadelphia Chapter for the Arthritis Foundation. Out of all monies allocated for disease research RA only receives 1% percent of all monies for research for disease prevention and control. Thanks Lori
2. Richard Faust Community Admin
 Hi Lori (<inline-mention username="MommaSwain01" user-id="6642322"/>). With latent TB, it is completely understandable that you would be avoiding the biologic medications. I do want to share with you this article I found on latent TB in rheumatoid arthritis patients: <a href='https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733747/' target='_blank' rel='noopener noreferrer ugc'>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733747/</a>. In particular, I want to note this paragraph which discusses treatments that may be options for those at risk of TB reactivation: "Another class of medications used in the treatment of rheumatic diseases is not biological iTNF such as: Anti-interleukin-1 (IL-1), Anakinra (ANK), receptor inhibitor of the IL-6 tocilizumab (TCZ), Anti-CD20 Rituximab (RTX), stimulus blocker of abatacept T-lymphocytes (ATB), Anti-IL-12 and IL-23 Ustekinumab (UST), and Anti-IL-17 Secukinumab (SEC). According to data from controlled clinical trials and national registries, biological non-iTNF not has a negligible risk of TB reactivation. Thus, probably, in these cases, the tracking LTBI is not necessary and these medicaments are the safest option in patients with increased risk of reactivation of TB." I don't know if any of these treatments may be options for you, but thought it might be worth a discussion of risks and options with your medical team. Wishing you the best and please feel free, if you like, to keep us posted on how you are doing and on any feedback you may get from the medical team (I know I am very curious). As a side note: I'm right there with you on the lack of funding and have plenty of thoughts that, hopefully, I can share later. Richard (RheumatoidArthritis.net Team)
Effie Koliopoulos Moderator & Contributor
I agree with this article. Some people in remission still experience symptoms due to existing damage or whatever else. I have been told once that I'm not in remission but "well controlled" and have "low disease activity" but one other rheumy said you can get better and low disease activity isn't all that great and can cause issues too. Precision medicine has helped me, having doctors really dig deep to look at all the bloodwork and do more than the usual ones to determine what medicine will work the most has helped a ton. Of course, it's trial and error still though it's better than just trying a random one. -Effie, team member
harpat949 Member
From what I know after extensive research, the best thing to do is never use any drugs for pain relief especially DMARDS and BIOLOGICS. They do not cure, they suppress pain in a small percentage of the users and even then they stop working for some people. They have serious side effects and they suppress immunity to other infectious diseases. The worst thing about them is you are advised not to drop them even if they don't work unless your Rheumatologist agrees and many will not agree. Even if they agree, alternative treatments may not work well due to the damage done. For those who never took any drugs, there are alternative treatments that work almost 100% of the time according to users. They are based on improving the gut microbiome using diet elimination technique preceded by a one day fasting and colon cleansing. The science behind this is best explained by Dr. Susan Blum in the book "Healing Arthritis". The most practical way to treat is best explained in the book by Giraud Campbell "A Doctor's Proven New Home Cure for Arthritis". His technique is acknowledged by users to work in a weeks time. No drugs or equipment needed. But the effectiveness is very limited for drug treated people and not as fast. Dr. Blum has suggested treatments for drug treated people but the process may take a long time, as much as a year and some expensive supplements are needed. It is necessary to phase out drug usage before treatment. 
1. harpat949 Member
 <inline-mention username="Lori Foster" user-id="4585696"/> I agree that not all dietary change methods work for all. In fact they should not because of faulty procedures. But one that works for all exists if you consider it worked for about half a million people who practiced it and there was no reported failures. These were done by clinics in Germany. In the US Dr. Giraud Campbell's procedure practiced by a Chiropractor has reportedly worked for every single patient. Here is his statement By <a href='https://Thriftbooks.com' target='_blank' rel='noopener noreferrer ugc'>Thriftbooks.com</a> User, December 3, 1999 As a practicing Chiropractor for 21 years, I can attest to the efficacy of Dr. Campbell's advice. I have treated dozens of arthritics his way and without exception, pain and inflammation are gone within a week, and the patient is on the road to recovery from there. And, most important, without the use of drugs. How the medical profession can continue to lead patients on, telling them there's nothing they can do for themselves, is nothing short of criminal. I sincerely hope this book will be reprinted. There are 3 other practitioners that are know to have similar success. After many years of denial, many reputed organizations are admitting connection between diet and RA and gut microbiome and RA. Examples are Mayo Clinic and Harvard Medical schools. Many prominent MDs also endorse the treatments as fully effective. This is not anything new. This was successfully practiced more than 100 years ago in India and for the last 50 years in Germany: Quote-- "The Ueberlingen clinic has been around for 60 years and the Marbella location for 40 years. Each year we have 3,000 to 3,500 patients at each establishment, which means 250,000 fasting cures without complications—it's not a scientific study but it's a statistical fact," the clinic's chief doctor, Stefan Drinda, said" The supervised fasting is followed by slow introduction of foods to detect RA triggering foods. On the other hand, the drugs do not cure according to the drug makers. They suppress the pain but not for many. When they do suppress the pain, most people cannot terminate the treatment. Very few have claimed remission and I suspect it may be due to change in diet or diet sensitivities and not the drug. 
2. Oldshmoe Member
 <inline-mention username="harpat949" user-id="5526436"/> Myself, I have tried every type of anti inflammatory diet including mind over matter. I ended up not treating a condition that caused irrepairable damage due to not treating or controlling the disease, and am now paying the price. In my experience, the people who are able to treat their arthritis without treating the actual disease don't have an actual rheumatic disease. These dietary cures only seem to help with osteoarthritis. Everyone I have encountered who claims they have success with dietary changes don't really have RA. They don't really understand the differences between osteoarthritis and RA. If you are successfully treating a rheumatic disease with diet only, I believe you to be the exception and not the rule.
olfalatumas Member
Boy... when do you throw in the towel is the million dollar question and one I sympathize with you over. I have such a great RA team and they have coached me through 7years of treatment thus far. My greatest success, in that I was in remission for 18 months, was with Orencia. I had been on methotrexate for 2 years and the side affects were too overwhelming so we went right to Orencia. Within 4 months I had outstanding results and within 8 I experienced remission. However, within that two year period on Orencia I developed a rash that, after 10 months of eliminating everything I was taking, eating, drinking etc. it came down to being a very rare case of Orencia allergy... so I had to go off everything for about 4 months to get it out of my system, before I could try anything else other than Metho and I chose not to go that route. Thus... it has been a tough road back. After 4 months I was put on Enbrel. Of course I was looking for that quick relief that I had from Orencia... it didn't happen and I have been on it now for 9 months and added Methotrexate at a low dose two months ago and I am just, in the past three weeks, feeling some significant changes in my pain and stiffness. I was ready to throw in the towel a couple of months ago but my trusted team suggested the Metho boost and give it some time. I am so glad that I did. I have a couple of friends, acquaintances really, that are so impatient to make things work that they do some really weird things against their doctors recommendations and are truly miserable. I have tried to convince them that some of these treatments take time... but you all know the story and maybe have been there yourself. They know better than their DR.s First and foremost... there is no cure for what we have, but it can be managed. Find a Rheumatologist that will work with you and for you and follow their guidance and keep active, eat well, exercise and do things that keep you positive. No cure... but we can get it manageable. Be good to you 
1. Lori Foster Community Admin
 Hi <inline-mention username="olfalatumas" user-id="3243485"/>. I am so glad you found a treatment plan that helps. My brother also takes Enbrel and methotrexate for PsA and experiences remission on the combination. He's been on it for at least 10 years now. I hope you continue to see improvements over time. Wishing you the best! - Lori (Team Member)
Orange21 Member
I have had RA for over 40 years and been on different treatment some worked some didn't. I am having a hard time coping with things I can't do anymore like quilting, losing my independence to drive but always finding a way to visit my family and friends. Of course you also get other issues with RA but I feel as long as you keep fighting the fight with all you have, each day is special!!!
opkk0x Member
I was on orencia for about two years and found relief after four months. The effectiveness waned and I transferred to Cimzia and have been mostly in remission for another five years. I seldom experience swelling unless I over extend myself. I have zero side effects. The Cimzia kicked in in about three months. My husband has psoariatic arthritis and takes Cimzia
Daniel Malito Moderator & Contributor
Oh, this is the age old question, isn't it? When is it time to say enough is enough and on to the next one? For me it was about a year and a half, sometimes 2 years. After that it became more and more readily apparent that the meds weren't working - until I found the one that passed the 2 year mark. Now I've been on that for almost 12 years. It's a difficult thing to decide - both physically and mentally. Keep on keepin' on, DPM
Nanette Member
You're article caught my attention because I'm thinking about throwing in the treatment towel all together! After several years of trying DMARDS, JAK inhibitors, and biologics and not finding a lasting, successful treatment, I'm not sure how much more I can take. I recently started Orencia infusions. I've had my three loading doses and am waiting for my first regular dose. However, it causes stomach upset. Trying to figure out if the side effects are worth the potential benefit (none seen yet). And, unless things improve soon, I'm not sure I can continue to work. 
1. Lori Foster Community Admin
 It's such a tough decision, <inline-mention username="Nanette" user-id="3218074"/>. I hope Orencia is effective for you and you finally get some relief. Thinking of you. - Lori (Team Member)
Oldshmoe Member
 I just found this board, so I thought I'd share my experience. I've been suffering with RA most of my adult life, but for some reason it didn't show up in my blood tests for years until I was diagnosed as sero-negative, and started undergoing treatment. Then, for some reason the tests started backing up the diagnoses. Needless to say, I didn't start getting treatment before the damage was blatantly obvious. I first started taking Prednisone and methotrexate, and had considerable relief till the side effects of the methotrexate became overwhelming. This crept up on me gradually, so I didn't recognize the cause till my Doc decided to increase methotrexate, which increased the side effects allowing me to recognize what was causing the symptoms. I then started Enbrel, which worked great to relieve the inflammation, but it didn't do anything for the pain, but every time I tried methotrexate, as soon as it started working, I would get some serious side effects, however, nothing else worked like methotrexate to relieve the inflammation and pain at the same time. I had previously tried Xelgans, and started getting similar side effects to methotrexate, so I went back to Enbrel. Now, I'm trying another JAK (Rinvoq), and immediately getting side effects, although not as bad. My BP is up considerably, and it makes me hyper and somewhat amped up making sleep somewhat of a challenge, but nothing like methotrexate. Those same side effects with methotrexate made sleep nearly impossible regardless of what drug I took. I am hoping I can tolerate the Rinvoq because I feel it relieving swelling even though I've only been on it a week. I am going to ask my pain management doc if I can add a tranquilizer to my meds at night. I do take minimal doses of Tramadol at night, but I try to minimize my use of opiates. the stronger ones just make me feel dopey and don't really do a lot for pain and sleep. For some reason the less effective Tramadol works better for me. I'm desperately trying to find some relief without being all drugged up. I've had the best success for sleep and pain with CBD weed that is 2 parts CBD to one part THC. It has just enough THC in it to make me not care about the pain so much, and the CBD sort of counters the psychoactive effect from the THC. This is very hard to find as the dispensaries only seem to carry what gets one stoned out of their mind. Wish me luck. 
1. L rick Phillips Moderator & Contributor
 <inline-mention username="Oldshmoe" user-id="6684988"/> I do wish you the best of luck. I have not taken XELJANZ or RINVOC. But i have used five biologic medications and in each case I have used Methotrexate. Thankfully I have not had the issues you describe with MTX. Nor do I use CBD or THC. However, I will say that if it works for you it is worth pursuing. I suggest this may be a great solution, but it will be great so long as you keep your doctor informed. I suspect most doctors will give advice, but as your journey continues you might run into hospital or surgical issues, if your doctor has not been informed and a new docotr requires a drug screen prior to a procedure. I wish you the very best, and do keep us informed about how things are going. CBD and THC are used by a number of patents to relieve pain. While that can solve the immediate issue of pain, these substances will not prevent more joint damage, which is the aim of JAK inhibitors and MTX.
harpat949 Member
Oldshmoe, I believe you that none of the diet experiments worked for you. They don't work for a good reason that only 3 or 4 practitioners understand. There are thousands others that don't understand. It has to do with microbiology of the gut. RA victims universally have bad bacteria in their GI tracks. They are often caused by diets that the patient cannot digest properly resulting in bad bacteria and leaky gut (Reference :Susan Blum MD, "healing Arthritis&quot😉. When you eliminate the offending diet, the good diet tries to introduce good bacteria. However if the number of bad bacteria in the gut is very large, they destroy or prevent the new bacteria from taking hold. So the good diet does not produce the desired result except in some patients whose bad bacteria count is small. So some patients do get relief with diet change only. Bacteria multiply very fast. In 10 hours, they can multiply by a factor of 1 million given the right conditions. They grow like mold growing in some bathrooms. So the experts have found a way to overcome this. The majority of the bad bacteria reside in the stools. So they ask the patient to remove most of the stools by means of fasting for a day or too and a laxative or enema to unload the stools. Dr. Campbell suggests only one day of fasting and an over the counter laxative or enema. Fasting helps because the food you eat today may take 24 hours to 48 hours to exit the colon. It is a long pipeline. So fasting gets rid of a good portion of the stools. This process is very safe. There are German clinics that use more severe form of colon cleansing, the same kind that is done for colonoscopy procedure. But it is done under medical supervision in the clinic. They do not recommend home treatment for safety reasons. One clinic reported they have cured more than 250,000 patients without any complications. There are other German clinics that use similar procedure for RA and many other autoimmune diseases. The name of one clinic is "Überlingen on Lake Constance." It is a massive operation in a resort setting staffed with top notch doctors and equipped with modern diagnostic equipment" . You can research it on the web. Foreigners can book a two to four week stay but it is not for the financially constrained. Another one is " The Charité" which is more affordable. You can find an article on Wikipedia. It says more than half the German Nobel laureates in medicine and physiology came from this Charité. While these institutes have impeccable records, I believe they are overkill from a financial standpoint. Doctor Campbells treatment costs virtually nothing (may be $6 for an OTC laxative if you don't have one). He has only one limitation. People who have been extensively treated with toxic allopathic drugs, Gold injections, DMARDS etc may not benefit though he does mention treating one such patient to substantial recovery. All other patients are pain free in a week. I am just one example. I am not talking about Osteoarthritis.That one is very difficult especially if the cartilage is all gone. The success stories are very rare and questionable. in fact I have some of it and the best i could do is keep it from progressing. A possible alternative to colon detox is antibiotics which need a prescription. It may be difficult to convince a run of the mill doctor to prescribe antibiotics in spite of the fact that several researchers have found the connection between RA and gut bacteria. Check on Google. Antibiotics can have serious side effects that can be overcome with probiotics properly timed. One big problem with so called healthy diets that you find advertised is that there is no such thing for RA. Diet sensitivities differ from person to person. So there are likely to be some components of the diet that are RA triggers for an individual. Another problem is lack of education and compliance. The person must be very vigilant. Any food should be treated as a deadly poison until it is proven otherwise by trial. It is too tempting to grab a cookie made of wheat or other individual allergen and make the diet change fail gloriously. After eating a healthy diet a person can get killed with less than a teaspoon of cyanide. So it is with RA. RA is not an incurable disease. The incurable disease is ignorance and lack of awareness perpetuated by the massive profit machine. check Wikipedia for a list of major pharmaceutical settlements and the reasons if you think I am an antidrug loony. It will be an eye opener. The drugs do not cure. The drug companies say so. All RA drugs get FDA approval on the basis that there is no cure. But FDA does not look beyond allopathy for cure. It is not heir charter and Allopathy finances them. I have seen many reports of people getting pain relief from drugs but that relief eventually ends for many. Many have found that the pain comes back to the original level or higher when the treatment is dropped which proves that the underlying disease was not cured. Full remission is so rare that it is doubtful if it was due to the drugs. It could be due to change in diet or diet sensitivity or some treatment like antibiotics. I wish you continued luck with whatever appears to work for you. I am not a doctor. So I cannot advice any treatment. I am providing information that you can use as a basis of your own research without reinventing the wheel.
MommaSwain01 Member
Hi, I have had RA for 20 years. I have latent Tuberculosis, I was treated for 2 years and it’s still active but not transmittable. I’m in Pain Management for 10 years. I’m not allowed to take infusion or injections. I take Turimic flaxseed oil, super bee, D3, 24 hour immune with elderberry, Croyle, zinc, and magnesium every day. I take Morphine and Percocet for in between pain. I’m 53 my Mom had it at 12 years old so it runs in my family.
1. Kelly Dabel Community Admin
 <inline-mention username="MommaSwain01" user-id="6642322"/> Appreciate you sharing with us. How is your pain management going? Sounds like you've found some great alternative supplements. Wishing you the best, Kelly, <a href='https://rheumatoidarthritis.net' target='_blank'>Rheumatoidarthritis.net</a> Team Member