Treatment for rheumatoid arthritis (RA) can be tricky — what’s worked for you in the past may not always keep your RA under control.
In fact, it’s fairly common to need an occasional change in your treatment plan, whether it’s a switch within a drug class or a step up from non-steroidal anti-inflammatory drugs (NSAIDs) to disease-modifying anti-rheumatic drugs (DMARDs) or biologic DMARDs.
Here are five signs that it may be time to talk to your doctor about making a change in your RA treatment:
1. You’re having a flare. Some people with RA experience periods in which their symptoms — such as stiff, swollen joints and fatigue — temporarily worsen. This can be due to stress, another illness, or sometimes no reason at all, according to the Arthritis Foundation. When this happens, your doctor may add corticosteroids — drugs that decrease inflammation — to your treatment plan, or increase the dosage of your current medication.
2. Your medication stops working. If your RA symptoms start creeping back after a period of being successfully controlled, it could be a sign that your medication isn’t working as well as it once did. Some people simply plateau on a medication after a certain amount of time, while others build up antibodies in their bloodstream that undo the effects of the medication. Be aware that this change can be subtle — symptoms typically don’t return with the same intensity as before you started treatment.
“Most people don’t go back to feeling acute pain,” Elyse Rubenstein, MD, a rheumatologist with Providence St. John’s Health Center in Santa Monica, California, says. “There’s usually just a slight increase in symptoms.”
When medications become less effective, a switch is usually necessary. If you take a DMARD, your doctor may recommend adding a biologic drug — an RA medication that works by interrupting processes in the body that cause inflammation. If you’re already taking a biologic, switching to another type of biologic might be an option. It’s important to work with your doctor to develop the treatment switch that makes the most sense for you.
3. You have new symptoms. If your RA typically affects the joints in your fingers, but you’re now having symptoms in your knees, see your doctor as soon as possible. “This change raises a red flag,” says Natalie E. Azar, MD, a clinical assistant professor in the division of rheumatology at NYU Langone Medical Center in New York City. If no other cause is found, this may be a sign that your RA is progressing in severity, and it may be time to change medications. People taking DMARDs are often switched to biologic drugs, which are typically used in people who have more severe RA symptoms.
4. You’re in remission. If you’re taking RA medication and haven’t had any significant symptoms in at least 6 months, you might be in remission, or a dormant period. Approximately 20 to 40 percent of people with RA achieve remission, according to research published in 2015 in Arthritis Research & Therapy. And while treatment is still recommended, people taking DMARDs or biologics may be able to taper their medications, the researchers note.
Doctors have differing philosophies on how to handle remission, but some recommend changing your medication routine — for example, by stopping one medication if you’re taking a combination of drugs. If you’re taking a biologic medication, you might switch to a DMARD, which typically has fewer risks and side effects. But stopping DMARDs altogether isn’t recommended, even for those in remission. And, though NSAIDs like ibuprofen and naproxen are sometimes used to relieve RA pain, research shows that they don’t prevent joint damage and aren’t an effective stand-alone treatment for RA.
5. You have an infection. People who take biologics have a higher risk for infection because the medication can lower the body’s immune defenses. According to research published in 2017 in the International Journal of Molecular Sciences, people with RA are already at higher risk for lung infections in particular, and taking certain drugs can further increase this risk. When serious infections like the flu or a bacterial infection occur, doctors usually recommend temporarily stopping DMARDs and biologics. “You don’t want to let an infection get out of control,” Dr. Azar says. “It’s much harder to fight off an illness when RA drugs are present.” RA medications are usually resumed after the infection has cleared. Just be sure to work with your doctor if you suspect an infection — don’t make adjustments to your treatment on your own.
Talking to Your Doctor About Changes to Your RA Treatment
When you visit your doctor to discuss changes in your RA treatment, thoroughly describe your symptoms, making special note of any new aches or pains you’ve noticed. Be sure to mention if your ability to carry out everyday tasks, like holding a cup or brushing your hair, has become more difficult. Above all, don’t put off seeking help.
“Don’t live with pain for long before telling your doctor about it,” Azar says. Know that it’s okay, even common, to need a change in RA treatment.