There’s no single treatment plan for rheumatoid arthritis (RA). If you have this inflammatory disease, chances are you’ll need to change your medication one or more times along the way.
There are many reasons why you may need to try something new. RA affects people in different ways, and the disease can get worse over time. So a medication that once kept your symptoms under control can stop working. Or the side effects become serious enough that taking the drug isn’t worthwhile. Sometimes, the way a medicine is given doesn’t fit with your lifestyle, or it interacts with another medicine you’re taking.
For whatever reason, your doctor suggests a new treatment. You may switch to a different drug in the same class, or step up from a nonsteroidal anti-inflammatory (NSAID) to a disease-modifying antirheumatic drug (DMARD), biologic, or janus kinase (JAK) inhibitor.
But before you make the change, take these steps to help the process go smoothly.
Prepare for trial and error. There are many RA medications but no surefire test to tell which one will work best. Your doctor will prescribe a treatment based on your disease, symptoms, goals, and other health conditions.
There’s a good chance that you’ll need to try a few drugs or combinations of them. For example, the first medicine given for RA is often a DMARD called methotrexate. But on its own, it only clears up symptoms (called remission) about a third of the time. Most people need to add on another medicine or switch to another one.
Even if a medication does keep your symptoms in check, it may cause side effects that you can’t live with. You may need to go through rounds of starting and stopping medicines to find out what works for you. Although the process may feel frustrating at times, it’s important to stick with the plan.
Understand what the medication is supposed to do. Not all RA medicines have the same effect. Some are meant to ease the pain and swelling. Others dampen the immune system, which slows or stops the disease process.
Talk to your doctor about each medicine that you’re taking. Discuss on how you plan on measuring whether the treatment is successful. This may include regular blood tests to track inflammation in your body, X-rays to look at joint damage, and questionnaires about your pain levels and quality of life.
Ask questions. Knowing the details fends off unexpected surprises. You can also check that the medication is the right fit for your lifestyle. Bring up these questions to your doctor:
- What side effects should I expect? You may feel them right away or after some weeks or months.
- What can I do to manage any side effects? Pairing your medicine with food and water may help ease stomach issues. If you’re on methotrexate, taking a folic acid supplement may reduce side effects, such as nausea and mouth sores, according to some research. Because many RA drugs suppress the immune system, getting your flu shot and other vaccinations can protect you from sickness.
- How is the drug given? Some are taken as pills, while others are injected. Some require infusions, which means going to the hospital, clinic, or doctor’s office regularly.
- How much is my copay? Many RA medicines come with a high price tag. Even with insurance, your out-of-pocket portion may cost thousands of dollars each year. Your doctor can prescribe a medication that works with your budget.
Track your symptoms. Taking note of your symptoms and lifestyle habits sheds light on how well a medicine is working. It can also help you and your health care team spot triggers, identify flares early on, and guide your treatment.
You can use a notebook or app to record your symptoms. Your doctor will tell you exactly what details to track. In general, you’ll want to note:
- Symptoms, their location, and the intensity
- Stress level and mood
- Medication use and dose
- Exercise, sleep, and nutrition
Give it some time. Although some medicines work quickly, others need time to build up in your system. DMARDs may take about 2 to 4 months to reach its full effect, while biologics and JAK inhibitors can require 3 to 6 months.
Follow your treatment plan exactly as prescribed. You may forget to take your medicine or skip it because you’re feeling good. You’re not alone: One study found that about 40% of people taking a DMARD or biologic strayed from their doctor’s instructions within 6 months.
Because RA is a chronic disease, you still need to take your medicine even if you’re getting better. Stopping may cause symptoms to flare and the disease to get worse. Plus, lapses may cause the medication not to work as well when you start taking it again. Talk to your doctor before you make any changes to your treatment plan.
Know your dosage. Sometimes the key to the right medicine is finding the right dose. Your doctor may start you on a smaller amount of the drug and gradually increase it over time. The goal is often finding the lowest dose that controls your symptoms. This can help reduce side effects.
If your side effects are bothering you, your doctor may recommend lower doses over time. Need to stop or switch to another medicine? You may need to “taper,” or gradually take smaller amounts of a drug, to lower your chances of flares or side effects.
Work closely with your doctor. If you have any side effects or symptoms after starting a new medicine, have an honest talk with your doctor. She can adjust the dose, suggest a new way to take the drug, or recommend a different drug altogether.
Back it up with lifestyle changes. Medication is only one part of an RA treatment plan. Your doctor will also recommend other steps, such as:
- Exercising, such as range-of-motion movements and exercises to build strength and endurance
- Resting the joints when they’re inflamed
- Eating a healthy diet
- Quitting smoking
- Cutting back on alcohol