After receiving an RA diagnosis, follow this general guideline for what should happen in the first two years. Everybody is different, however, so talk to your doctor about the treatment timeline that's likely to work for you. "If you are functioning as you need to for your life, your arthritis is well controlled and you're not having excess pain, then your treatment is on target," says Arthur Kavanaugh, MD, rheumatologist and director of the Center for Innovative Therapy at the University of California, San Diego. If you’re not on target, take control with these steps.
At the first sign of symptoms: Make an appointment with a physician for a diagnosis. Joint damage will be assessed using MRI or X-ray. Prognosis will be estimated based on age, test results and the presence of other rheumatic conditions, such as Sjögren's syndrome, and any involvement of the lungs, heart, spleen or blood vessels.
Within two months: Methotrexate usually will be the first disease-modifying antirheumatic drug (DMARD) prescribed. Methotrexate takes one to two months to show benefit, so consider a nonsteroidal anti-inflammatory drug (NSAID) or analgesic for pain while the methotrexate begins to work.
Within six months: If methotrexate is not working by now, your doctor may switch you to another DMARD or add a biologic agent. Monthly or bimonthly liver function tests will be done if you’re taking Arava, methotrexate or Remicade; periodically if you take cyclosporine; and yearly if you’re taking salicylates or other NSAIDs.
By one year: If examinations and tests show disease activity, progression or joint damage, your doctor may step up your medication.
After two years: Disease activity and progression will be monitored at each visit. Discuss the effectiveness of your medications and any health problems you experience with your doctor.
Always: Throughout your treatment timeline, continue to take control of your health. Learn about your condition, exercise regularly, eat well, lose weight if necessary, stay socially active and protect your joints.
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