Everyone is affected differently by rheumatoid arthritis (RA). Generally, however, most people with RA will experience flare ups, which are periods of worsening symptoms such as stiffness and joint pain, or develop new symptoms.
Even if your RA treatment plan is working well for you right now, it could become less effective or cause more flare-ups.
It’s not unusual to need to adjust your treatment plan over time. You and your healthcare provider will decide together when you might benefit from a treatment change.
Before you make any changes, consider the pros and cons.
Why switch to RA Medications
It’s a good idea to continue with the treatment you have chosen together with your doctor. You may be able to benefit from revisiting your treatment strategy if you:
- Your RA symptoms have become more severe, including increased joint pain, swelling, and fatigue.
- You’ve developed new RA symptoms.
- You’re unable to control RA flares.
These are signs that your RA treatment plan may not be working as well as it used. Nilanjana Bose MD, a Houston rheumatologist, says that if you aren’t doing well or you’re unhappy about your treatment results, it is normal to try to improve the efficacy.
It is important to consult your doctor before making any changes. Dr. Bose says that it is important to consult your doctor before you start or stop any medication. This is because the underlying condition may flare up or may have untoward side effects.
To determine if you have any inflammation, your doctor might request bloodwork. You can then work with your doctor to determine if you should change your treatment.
What are the Pros and Cons to Changing a RA Treatment?
Changing the treatment for RA can have a variety of benefits and risks. You can make informed decisions by discussing the pros and cons of each option with your doctor. Before you decide to make a change, here are some things to consider.
- Pro: There are many options. There are currently a dozen disease-modifying treatments available to control RA and stop its progression. Many more are in clinical trials.
- Pro: Some newer treatments may be more effective that traditional ones. Methotrexate (a disease-modifying antirheumatic drugs (DMARD) has been traditionally used as the first line defense. Research shows that you may be able to control your RA by adding newer options, such as a biologic drug or Janus kinase inhibitor (JAK), to it. While biologics are effective in treating RA, JAK inhibitors are more effective than certain biologics.
- Pro: There are newer options that lower the risk of developing RA-related heart disease. An increased risk of developing heart disease is associated with RA. In a study that involved over 4,000 people with inflammatory arthritis, a decrease in major cardiovascular events was found to be associated with biologic use.
- Con: Other options could pose serious risks. All JAK inhibitors include a black box warning that lists an increased risk for cancer and other serious heart problems. This includes blood clots and heart attacks, stroke, and blood clots. The risks associated with RA are considered to be minimal for most people, particularly when compared to the potential risks of not treating the condition or undertreating it.
- Con: It can be hard to determine which drug or combination of drugs will best help you regain control over your RA. Bose says that what works for one person might not work for another. This is why you should consult your rheumatologist if you are considering switching to another drug.
- Con: Sometimes it can take a while to determine if a new treatment works. Newer options like JAK inhibitors can take effect in a matter of days or two weeks. However, biologics and DMARDs will likely take a while before you experience the full benefits.
- Con: It can be difficult to change treatment without a lot more follow-up. You may need to visit the doctor frequently and have lab tests done to determine if a new treatment is effective. It is worth the effort: Keeping track of your RA treatment plan will help to prevent joint damage and maintain joint function.
- Pro: It is possible to achieve or regain complete remission. A review published in October 2017 in Therapeutic Advances in Musculoskeletal Disorder found that RA sufferers are more likely to experience sustained remission. This is probably due to the availability of targeted, newer treatments.
Get to know your doctor.
Talk to your doctor if you think you might benefit from a treatment modification.
Bose suggests that you sit down with your partner and review all of your medications. Then, think about the reasons why you are not responding. To ensure you are following your treatment plan, it is important to discuss it with your doctor. Your doctor might also mention factors that may be contributing to your symptoms. Then, you can determine if the drug is failing or if your symptoms are caused by something else.
Working together can help you make informed decisions about your treatment. Bose adds, “Every medicine has its own baggage.” You and your healthcare provider will be able to weigh the pros and cons of each treatment option and create a plan for getting your RA under control.
Sherry Christiansen also reports
