Sam Williams and his parents knew something was wrong when it hurt for the 8-year-old to grip a baseball bat, but they never considered juvenile arthritis.
It hurt to write, giving Sam a sound excuse for not wanting to do his homework -- or even his work at school. After several weeks, Sam's pain grew worse -- and moved into his knees. He also had pain in his jaw and had trouble walking.
"His brother had to carry him piggyback up the stairs," says Rose Williams, Sam's mother.
After several months,...
"You see the majority of your patients doing great and living a normal life," says James R. O'Dell, MD, chief of rheumatology and immunology at the University of Nebraska Medical Center in Omaha.
If your doctor recommends combination therapy, this is what you can expect.
Who Gets Combination Therapy for RA?
Most doctors start newly diagnosed RA patients on one drug, usually methotrexate, and adjust the dose if needed. If your RA doesn't respond, your doctor may add another drug.
Some doctors will start patients on combination therapy at the beginning of treatment they see signs of more severe RA.
What Drugs Are Used?
Methotrexate is often one of the drugs used in combination therapy for RA. It can be used with another drug in its class (such as hydroxychloroquine, leflunomide, and sulfasalazine) or with a biologic drug.
There are several types of biologics that treat RA. They work on your immune system to reduce joint pain and swelling, curb inflammation, and help you move better.
Rheumatologists don't combine two biologics because of the higher risk of infections.
Benefits and Limitations
The benefits of combination therapy can include less joint pain, morning stiffness, and inflammation. It can also help slow or stop the disease from worsening. That can mean a more active life.
Some people may have remission, meaning they don't have any symptoms of RA.
Combination therapy can't reverse joint damage that you already have. But it can prevent further damage and help reduce the risk of health problems that may accompany rheumatoid arthritis, such as heart attack and stroke.
It’s not possible to predict which combinations of drugs will work best for you. It may take some experimentation to find your combination.
Mark C. Genovese, MD, professor of medicine, Stanford University; co-chief, immunology and rheumatology, Stanford University Medical Center, Palo Alto, Calif.
James R. O'Dell, MD, Larson Professor of Internal Medicine, University of Nebraska; chief of rheumatology and immunology, University of Nebraska Medical Center, Omaha; secretary, American College of Rheumatology.