1st level is just your basic anti-inflammatories or NSAIDS, like ibuprofen, aspirin, naproxen (aleve) and other prescription ones (I've tried two others, and have settled on one called diclofenac). These help manage inflammation - unless it's too inflamed. However, I will never forget my diclofenac. My doctor had me go off it early to get a feel for what my body was doing off meds. BAD IDEA. I couldn't move for two whole days.
2nd level is steroids. The most commonly prescribed is prednisone. I've been given this at times to try to tamper a flare.
3rd level are DMARDs, or disease modifying anti-rheumatic drugs. The first one tried is usually a drug called plaquenil, which is actually an anti-malarial. If you fail on that (nothing changes) you can move up to methotrexate. This is the most common medication prescribed to people with RA. However, it is a chemotherapy drug (the dose is much smaller) and induces miscarriages.
The final rung, if you fail with DMARDs (specifically methotrexate) are biologics. If you've ever seen the commercials for people with arthritis to live their lives better - you're listening to an ad for biologics. Humira, Enbrel, Orencia, etc. These are all drugs that must be injected directly into the body, either through IV or injections. Woooo.
So, I went to the doctor on Friday, and I've been taking the diclofenac and plaquenil for 8 weeks now. And I've only gotten worse. Last week, I was shocked at how much the heat and humidity caused my right forefinger to swell - so much that I couldn't straighten it. He took more sonograms of my hands and feet to see the inflammation and he said we need to move on. The next step would logically be methotrexate - however this is a problem.
Getting RA at this point in my life has been an even bigger pain than it could be, all because I am planning on starting a family sooner rather than later. As I said above, methotrexate causes miscarriages, so I can't be on that drug. And it also takes 3 months for it work out of your system - so starting it now would just be a waste of time and money. However, in order to be bumped up to the biologics, you have to have tried and failed on methotrexate. I won't have any clue if methotrexate will work for me for at least a year or two. Now, getting pregnant will probably mean that symptoms will be reduced (the immune system gets repressed, and then it won't fight me anymore!) But, to not be on a stable medicine for that long is scary!
We decided to jump down to the steroids, and now I am on a course of prednisone for the next 25 days, starting high to kill the inflammation, and then tapering down until I'm taking 5mg every day. Hopefully, this will help me feel better (it already has at the high dose, I did a bunch of yard work today!) but there are so many crappy side effects, like mood swings and weight gain, that I have to deal with.
The one good thing to look forward to, which is funny in a way, is that my doctor found an area in my pinkie toe on my right foot where the bone is eroding. You're probably sitting there going "What the hell is she talking about? How is that good?" Well, if he can prove that my bones are already showing erosion, then he might be able to convince my insurance company to skip methotrexate and get me on a biologic. Just gotta wait until he gets a more powerful and sensitive ultrasound machine.
Another doctor's appt tomorrow - This time with my OB/GYN, just to keep him abreast of the whole situation....
Dealing with RA and trying to start a family is a scary and complicated - it's something I've been looking into lately too (though I know I haven't posted about it on my blog yet). Unfortunately, I haven't been able to find that many resources out there to help with that journey. In any event, my point is this - if you ever need someone to talk to or bounce ideas off, shoot me an email: FromThisPoint.Forward@gmail.com Maybe we can learn about it together. ~;o)
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