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.
Arthritis Treatment Timeline
Take control early to avoid joint pain and damage
Dawn 19 Nov 2009, 21:50 |
| Hey Danielle I know you posted your message a long time ago, so I don't know if you'll get this or not, but don't give up! I am 27 and was diagnosed with RA when I was 11mos. old, so I have dealt with this for twenty-seven years. And believe it or not, it does get better! The majority of my childhood sucked! Constant pain, little to no mobility, I spent sixth grade in a wheelchair. So I know that this can be so challenging and overwhelming. Thanks to the help of MANY Dr.s some good and some not, the support of family, nine surgeries and trying so many different drugs that I have probably forgotten the names of most, I am doing better than ever. I just graduated from college and am currently looking for a job. I am engaged and my RA is under control. Yeah, I still have really painful days when I don't even want to get out of bed, but the good days outnumber the bad right now and that's something. You will always be able to go back to the gym, you just have to change the activities you do until you find some that work for you and do not push yourself too hard. Talk with your Dr. and don't be afraid to try new things. Yeah, sometimes the side effects are bad, but they do not always affect you. Good Luck and don't give up! |
Margaret 19 Nov 2009, 05:42 |
| Bonnie, Please have your eyes checked. I had to go off plaquenel after 10 yrs. because it affected by eyes. It was found by a field vision test. Now I'm experitmenting with different drugs. Do not feel well like I did before. Hopefully the MD & I will find the right combo. I was on the same combo as you and was doing very well. Take care. |
Annette Kerubo 10 Nov 2009, 07:13 |
| I was diagnosed with RA back in November 2007. I was given Diclophenac tablets to use to reduce the pain. This used to work for only a few hours and the pain would come back, stronger. I was then given Ponstan that i used for several months. I had pains in my eyes that hurt so much. When it was active, my eyes would start tearing and i would feel so much pain accompanied by serious headaches. The doctor told me that RA sometimes affects the organs like the eyes, liver etc.I stopped the medication as soon as the pain went away. The RA is inactive now. Should i continue with medication? |
Lesley 16 Oct 2009, 08:42 |
| I have had RA for almost 19 years. I have had 4 surgeries, and believe it
or not, pain free. it took alot of experimentation to get here. you have to
be willing to try the new drugs (biologics), they will slow the
progression. You may have to try several till you find the right one. Diet,
weight loss, exercise, all help, BUT they do not replace the meds. I have
heard it all! If there was a cure, we would all gladly partake. Hopefully
someday sooner than later, there will be. The idea is to slow the
progression of the disease. The sooner you begin TX the better. Personally,
I did not want live with the pain,and until I found the right
rheumatologist, who shared my belief, and listened to me, took my many
calls early on, and worked with me, I would not have been satisfied. I had
3 different internists tell me to take tylenol, there was nothing wrong. It
took almost 5 years to finally get a diagnosis. Palindromic disease turned
into RA. Unfortunatley, I did not have tx's that could have helped my hands
and feet fast enough. Please be your own advocate, keep pushing. call the
drug companies for help to get their meds. I say, try the drug before you
decide the side effects are scarry. Every drug has a list of side effects
which rarely occur in most of us. If you don't do well with one, try
another. Most of the side effects reverse themselves when you stop the med.
Plus your rheumy should be drawing bloodwork regularly. prednisone is a very useful drug, but it can do alot of damage over the long term, besides, it does NOT slow the disease destruction. There are so many new drugs out there which can really make a difference in quality of life, and they do slow the progression. Remember, what works for you may not work for someone else. Which is why a rheumatologist is so important. They know and work with these drugs everyday. They know the cutting edge tx's, as well. Your choice, possible side effects, or not, and a much better quality of life?, or pain and disease progression, poor quality of life? The likelihood of this disease getting worse is probable. So, what do you choose? I have taken enbrel for about 6 years with no side effects, 50mg inj. once a week, when and if that stops working I will move on to the next med. but so far so good. I take mtx-6-2.5mg tabs weekly, the day befor my enbrel. no folic acid the day I take mtx. I take 500mg twice aday of azulfidine, 75mg twice a day of voltaren, a multi vit daily, and 1mg-folic acid daily. I am feeling great, except for the occasional ache, but that is like the rest of the population! Good Luck |
joyce 28 Sep 2009, 21:18 |
| I was recently diagnosed with RA. I have no insurance and don't "qualify"
for help through the state. I decided I would do whatever I can in my
abilities to control this --- I cut out red meat, dairy, coffee, bread
(gluten), and sugar. COLD TURKEY. That was 7 weeks ago about two weeks
after I was diagnosed. Well, I do feel better, my pain is less severe than
it was, and on top of that I have lost 16 lbs. I did need to loose the
weight, they say that helps. I have simply began eating a nearly vegetarian
diet. I still have a piece of pork or chicken now and then but mostly I am
eating salmon, tuna , etc. tons of fruit and veggies. Beleive me I was a
complete sugar feind and I don't even get urges. I wish I could get in to see a Rhumatologist but for an uninsured person they want $500 for an initial visit. So, I can only imagine what the meds cost. My primary physician did give me a Rx for prednisone to take for flare ups. I guess that will help, although I think I've had this for about two years when I think back on it, there have been many flare ups. Good luck to all- stay positive and eat right :) |
Lisa 27 Sep 2009, 14:21 |
| I find comfort in knowing I'm not alone with RA. I thank each of you for sharing your experiences with me. The pain makes me angry too. There's so much I want to do each day but I feel so tired and irritable. I try to take one day at a time. Feel free to e-mail me at STILLDREAMING21@msn.com |
Carol 10 Sep 2009, 10:28 |
| I have had RA for for years. When first diagnosed I was on 5mg of predisone and 50mg of liquid gold injections once a month. That was good for a period of time. I then went to a rhuemotologist who weened me off the predisone and put me on Humira and Celebrex. The Humira did not work well so I am on Enbrel, Celebrex and the gold injection. I also have started to walk 5 out of 7 days for 1 hr. a day. I now only have to take the Enbrel injections once every 3 to 4 weeks not weekly. I really think if you can get the pain under control and begin to exercise it is a great help for RA. My life has become fairly normal because of all this. It was miserable and painful at first. Hope this helps someone else. |
Jeanette 24 Aug 2009, 10:58 |
| I have read everyone's comments and it saddens me what we are going through. I am having a bad flare up today and I am miserable. Desperate, to find more help I ended up here. I am taking sulfasalazine and naproxin. I understand these medicines have an accumulative effect. My first pregnancy put me in remission for 3 glorious years. I just had my second child, which awakened the devil. And I have full blown RA again. I just keep hoping a cure with be discovered. I looked into arthritistrust.org, it seems odd if there was a cure on the 1970's that it is not being used. |
Bonnie Morehead 10 Aug 2009, 15:32 |
| Yoga and exercising everyday are saving my life. I take a an hour class everyday and walk a mile a day. I never miss my exercise. When I can't get to the class I use a tape at home, however the class is better. I am following a diet in the book Too Young To Feel Old, by Richard Blau, M.D. Lots of garlic, turmeric, fresh ginger, lemon, cinnamon, oregano and walnut oil allanit-inflamatory spices. Every recipe I have tried is very good. Fish, chicken and london broil so there is a good verity. I take plaquenil,prednisone and meloxicam, but I believe exercise and diet are the key. Good luck to you all and be thankful for the many blessings in your life. Don't let the pain win. |
Maria Renee 07 Aug 2009, 21:55 |
| Last year, after 5 months of visiting different kind of doctors and getting
the most unbelievable diagnosis, having different lab tests and Xrays done,
and taking all kinds of painkillers, sleeping pills, antinflamatory drugs,
prednisone, etc. and suffering of terrible pain in arms, shouders, legs,
knees, neck and hips and at the end I could hardly walk or do the easiest
things, I was diagnosed with RA, I am on prednisolone and methrotexate and
it has already been 7 months and I can say both medicines are working, I
have pain but nothing that can be compared with the pain I had before. I
have a normal life, expect for somethings, for example, I get infecctions
more often than I used to before. I can not drink wine, because I get sick
of my stomach, I can not do rude movements or lift heavy things, and the
most important I have to sleep well, be calm and do not do a lot of things
in a single day,if I do, next day I am in pain. I have noticed that stress
is the worst for RA. It has been hard to accept I have RA, but thanks God I
found a good doctor who has helped me and has given me the medicine that is
working for me. I have some side effects of the methrotexate but they are
not that bad, I use the subcutaneos inyection once a week and I take folic
acid everyday. Every person is different but I hope my story helps other people. |
Mary 05 Aug 2009, 12:07 |
| My situation with Methotrexate and Prednisone are the same...1st the pills
worked and then needed to go to injections now they are not working. I am
on 40 mg pred daily and have been removed from work and going to lose my
job either way do to the palindromic attacks I am continually having in my
larger joints..the pain is unbearable and the dr told me to take the pred
on the start of attack and go to the er or urgent care for pain management
if needed more then perscribed..they treat me like a drug addict when I am
only asking for help at the hosp not to take anything home or anything...my
husb has even been accused of abusing me and that is why I am in the pain I
am in which is crazy...then they refused to treat me and made me leave with
no help at all in terrible pain..this last visit my dr told me to go to
urgent care for an injection of inflamitory med because he didnt have the
opening and couldnt give it up in his office...they refused and treated me
the same way again... I have been looking up alternative treatments and found arthritistrust.org I am really wondering after reading everything if this is a route to go...at least to try it. any opinions from someone who has read the same information on the study and protocal... please email me back at mkconstancio@gmail.com |
Pam 03 Aug 2009, 13:13 |
| Has anyone else ever had the problem that the RA medication (mine is Methotrexate and Prednisone) worked for a few months then seemed ineffective? If yes, what did your doctor do? |
D 21 Jul 2009, 08:49 |
| I understand how everyone feels! It is frustrating! But try what you can. I agree with the bell pepper and red meat. I even find that weather (pressures?) is a factor. Just like other things, you have to find what works for you. "How to Eat Away Arthritis" has helped me and others I have met with RA. We as a community must beat this! Give these things a try...you just never know. I keep believing there is something positive...you change what you know affects you, even if it is hard. I loved bell peppers, even the smell, but I decided I love walking and doing things with my kids and friends more. You won't miss them that much! Look at it this way- if you were allergic to peanuts or a medicine, would you take them? No..so keep your head up and try whatever you can until you succeed! Read that book...try some of the ideas like no peppers or cooked tomatoes and sauce (it raises the acidity in your body I think?)-it might work. :) The positive is knowledge. |
Debbie 11 Jul 2009, 10:08 |
| I recently had the signs of carpel tunnel in my hands, so I went to my doctor and he put me in the hand braces. When that didn't work, he sent me to an Orthopedic doctor. When the Orthopedic told me that I had hands of a 30 year old, (I am 45), and that I didn't have carpel tunnel, that it must be a nerve problem. I was then sent to a neurologist, who did tests and of course, I didn't have any nerve damage, or problems with my spine. By this time, I was very very aggravated. I am a very active person. Then came the rude awakening. I woke up one morning with such intense pain, and I could lift my right arm up or out. I called my regular Doctor and told him that I wanted blood tests, x-rays, whatever. I had to know what was going on. That is where they found out I had RA. He promptly told me he would refer me to a Rheumatologist. I told him I would find my own Rheumotologist as I wanted the best. I calle him back with a name and told his staff to make my appointment for me. I got a call from the Rheumatologist office the next day. I am now on a course of treatment that I decided was best with the recommendations of my rheumatologist. I have been on the treatment for 3 weeks. I feel that if we don't get aggressive with the Doctors on our treatment, we will just be pushed aside. I have also found a great many ideas in the the book Alternative Treatments for Arthritis. I have found that by doing some of the alternative treatments and the plaquenil and celebrex, I am managing my pain and disease. Not to say that I don't have bad days, I do, but I refuse to get down about my diagnosis and let this disease win. After all, studies have shown that if we allow the pain to get us depressed it is worse. I know that I am in the early stages, but, I will continue to research and follow the information on this disease. |
laurie dumont 23 Jun 2009, 03:03 |
| I have been in constant pain for 2 years now. My right leg was 3 inches
bigger than my left and I got that swelling out with serropeptase (a
homeopathic antiinflammatory) scrip ones did not work. They call mine asymmetric seronegative spondyloarthoapy(means no ra)and possibly psioratic arthritis. In other words they dont know. The pain is unbearable. I cannot sit, walk, do anykind of work, without it taking day. First I had prednisone, which cause a pregnant belly, then they added tylenol 3, for pain and advil for inflammation. Then dilaudid. Well all I did with that was took so much I didnt know who I was. The methotrexate is not working after 4 months, and I am getting tired of the side effects. hair loss on eyelashes, itching badly, sick to my stomach all the time and dont eat for days. all this and they still dont know what is wrong. when i found out the methotrexate caused lymphoma I freaked. Why would I purposely want to get cancer on top of all this pain |
Pam 20 Jun 2009, 19:34 |
| I know how you feel Rosa. I was there too and I still feel like that myself several times a week. My whole life has changed from what was normal to me. December 2007 I woke up one morning and could hardly move and hurt everywhere. The same thing had happen to my mother 12 years earlier. The pain would be unbearable for days on end. My general doctor ran the tests and said that I had RA 4 months later then he referred me to a RA doctor which took another 6 months to get into as there isn't enough RA doctors for the amount of people who has RA. I was started on methotraxate which helped some but the side effects weren't pleasant. Too much stomach problems. Now I'm on the injections for 2 weeks now waiting to see if it helps me any better. We all need a cure not more bandaids. Good luck to everyone who is suffering through this with me. I wouldn't wish this for anyone. |
Sandy 26 May 2009, 20:51 |
| I have read all your comments and generally have to agree with what you all have had to say. I am 58. I basically diagnosed my RA before I could get a doctor to diagnose RA. (I have worked in the medical field for several years). I was first put on Prednison, then Plaquenil, then switched to methotrexate. After my liver functioning test came back with elevated enzymes, I was taken off that med for three weeks. After the three weeks I spoke with my Rheumatologist and asked if I could stay off all meds. I had lost my job and began exercising for an hour each day (I had exercised for at least 30 min/day for the past 20 years). I then joined the "Biggest Loser" online. It has been great. I originally weighed 157 and now I am down to 149. I take a med called "Trigosamine" which I get through the mail. It contains: RapidFlex-helps with the anti-inflammatory response, Hyaluonate13, and Glucosamine15. I generally do not have as much pain in my knees or as often as I use to. My feet are what hurt at times - and especially when the weather changes. I am not fatigued like I used to be. I really believe that exercise and a more positive outlook have helped me a lot. I really do like to talk to others who are going or have gone through what I have. Hope this helps someone. |
Cindy 25 May 2009, 21:14 |
| I have just ben diagnosed and I'm very confused. Some of your comments do not help and make it even more intimidating. Are there no positives? |
Shari 27 Apr 2009, 23:17 |
| I am pretty new to RA, as of last August. I have been on prednisone since.
I have been trying to conceive, but this will be our last few months of
trying. I am tired of feeling exhausted. I make it through the day pretty
good. It is just hard to wake up and hard to stay active when i get home.
I am gaining wieght after just losing 30lbs. this just sucks. I am a PE
teacher and coach and i am not ready to give up my love. I want to feel
somewhat normal. If there is a good book, I would love to have someone
tell me about it. I am afraid to go on all meds because of the side
effects. What do you advise or promote through your experiences. I am on
prednisone and anti-imflamatories. Let me know your story, and help me. I
am nonserum, RA. Thanks |
Ellen Galo 22 Apr 2009, 08:38 |
| If a person still isn't functioning, then something more or different needs
to be done. I have heard of, or talked with, a couple of people who are on an antibiotic protocol for RA and feel that that helps slowly but steadily, with less worry about side effects. I don't know for sure, but it may be the answer for those for whom nothing is working, especially if you are 'sero-negative', i.e., blood tests are negative for rheumatoid factor. (I am not a medical professional, this is what I've gathered from reading and a few conversations from people on the antibiotics - see "The Road Back" website or book). Dietary - there may be a relationship between RA and some foods. Some people get better if they avoid dairy foods. For me, I have less pain if I avoid green peppers (nightshade family - also includes potatoes, tomatoes and eggplant, for those who are sensitive. I avoid cooked tomatoes or tomato sauce due to acid reflux. I don't like eggplant. Potatoes don't bother me as much as green peppers. Red meat makes me depressed & foggy and gives me PAIN. ALSO, studies show that vegetarian or vegan diets reduce pain and can help that for a long time. HOWEVER, it will not reduce the progression of the disease - but pain reduction is worth. When my pain gets worse I sometimes cut out meat for a week. Fish is better, (all those omega-3s) I don't necessarily cut fish out. EVeryone has to make their own decisions and see what works best for them. But I hope these suggestions help. |
sally 21 Apr 2009, 12:10 |
| I have been reading books on nutrition to help with the flare ups. It helps to eat correctly and know your food sensitivities. However, staying on a strict diet is impractical so pain still persists. I am terrified of the drugs that they use and take minimal amounts of Methotrexate. I refuse to take the newer biologic drugs because the side effects listed are endless. |
Lynn 20 Apr 2009, 10:36 |
| I agree, I get SO angry when I read all these articles about someone running a marthon or climbing a mountain that has RA. I keep wondering when will I ever be normal. I am so tired of waiting until something works. I am literally exhausted all of the time, I don't want to go to the gym, I just want to sleep. |
Danielle 20 Mar 2009, 22:40 |
| Is there hope with these meds I have tried methotrexate, and i now take sulfasalazine, plauinel, and I'm still on prednisone that no longer seems to help I'm also on enberel I'm only24 will I ever be able to get back in the gym? |
Pamela D. Miller 10 Mar 2009, 00:43 |
| I can totally sympathize with you Rosa. I wonder the same things. When am I going to feel like my old self? When am I going to be able to get out of bed without sitting there first for at least an hour or more? I am experiencing some side effects from the Humira and Methotrexate which are making me feel worse. I guess the saying "the cure will kill you before the disease" that is how I'm feeling right now. |
rosa m salazar 09 Mar 2009, 15:42 |
| are you suppose to have pain every day??? Does it every get better or just
progressively worse. Is there certain foods that should be eaten or a book
with meals that are recommended. Please advise. when is your next medical conference on rheumatoid arthritis???? |
