This One-Size-Doesn’t-Fit-All post is especially for those newly diagnosed with rheumatoid arthritis (RA), but the concept remains relevant throughout the autoimmune journey.
We are all one-of-a-kind, so when diagnosed with rheumatoid arthritis (RA), my medication choice was based on my unique body and life circumstances. A bit like shopping for shoes, I like to look at what styles are trending, but the final decision on what I buy depends on how the shoes work for me. This describes the approach I took when initially deciding which medication(s) to treat my RA. I considered the most recommended drugs, but the ultimate decision was based on how well the particular medication fit my unique situation. I knew one size (medication) doesn’t fit all.
My RA diagnosis came after years of weird pains, extreme fatigue and an overall sick feeling like I had the flu. My lab tests didn’t lend a clue as they were still normal, or seronegative. That means inflammatory markers often elevated in diseases involving inflammation were not in my case. My joint pains were never symmetrical, but randomly appeared in one shoulder or one knee, or one hand. The moment I felt pain in both wrists was when the MRI imaging was indicated. The MRI result showed the synovitis consistent with RA. I was ready for aggressive treatment, thanks to my pharmacy background.
Here are the three steps I used to determine my medication plan:
- What are the most recommended medications that show greatest promise to relieve the symptoms and arrest the progression of the disease?
- What unique sensitivities, potential contraindications or other considerations do I need to keep in mind and use to determine what medication(s) is best for me?
- What does my insurance cover?
Disease-modifying antirheumatic drugs (DMARDs) were number one on my list to treat my RA. They are strong medications that are necessary to treat a formidable disease like RA that needs to be stopped in its tracks, if possible. I wanted to give my body the best opportunity to go into remission. My physician and I decided methotrexate (MTX) would be the best choice.
For a nanosecond we considered minocycline, as I also have rosacea. Minocycline is a medication used in the treatment of both conditions. In the end I wanted to go bold and focus on the RA as my rosacea is fairly well controlled. With good liver function, I wasn’t pregnant, I didn’t have a job with a lot of sun exposure, and I wasn’t allergic to methotrexate, making MTX a good choice for me.
Methotrexate is a low cost medication, although the necessary periodic lab tests need to be figured into the total cost of using the drug. It was covered by my insurance plan so that sealed the deal. I needed to take prednisone as a bridge until the methotrexate took action in my body. My prednisone was tapered down as the methotrexate started to work. In my case, I tapered down to about 2mg for a long time before I was able to stop it all together. The details about my prednisone taper will be the subject of another post.
Not only is the initial medication plan not a one-size-fits-all, but treating RA is a fluid situation in that monitoring the effectiveness of the drugs, potential side effects, drug interactions needs to happen. The medications sometimes work until they don’t work. Autoimmune diseases are unpredictable. So what medication plan we start with likely will change as time goes on. I added a biologic after 6 months, then was able to discontinue the prednisone and methotrexate after I had a surgical procedure. That will be another post, too!
We are all unique with different lifestyles to consider when choosing our RA treatment. I pay close attention to what medical studies reveal to help us make our decisions, but in the end it has to fit our particular situation-just like a good pair of shoes!
I’d love to hear your story. Please share in the comments below.
And that is using Arthritis Wisdom!
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