When Do You Throw in the Treatment Towel?
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!
What strategy to fight fatigue is most effective for you?