“It’s important that people with RA monitor their symptoms closely and know their ‘normals’ and ‘abnormals’ to make sure that they are still responding appropriately to their treatment,” says Shereen N. Mahmood , MD, a rheumatologist at Montefiore Medical Center and assistant professor of rheumatology at Albert Einstein College of Medicine, both in New York City.
Your RA Management Plan May Need to Be Adjusted Over Time
Everyone’s experience with RA is different, as is how well the condition responds to treatment. So it may take some time — and trial and error — to find the right medication regimen. Most people newly diagnosed with RA start treatment with a disease-modifying drug called methotrexate. But many will need another drug to achieve full symptom control, according to the Arthritis Foundation. “When changing medications or doses, you may experience a period of mild RA symptoms associated with waiting for the new medication to take effect or mild side effects associated with the medication or dose change itself,” Dr. Mahmood notes. “Often, these symptoms resolve with a little time, but if they persist or worsen, you should talk to your rheumatologist.” Even if you’ve achieved remission, your RA symptoms could return, particularly if you taper your dosage or stop taking your medication altogether. In fact, in a study published in June 2020 in the Annals of the Rheumatic Diseases, 63 percent of those who had their anti-tumor necrosis factor (TNF) dose tapered experienced a flare, and 19 percent showed signs of disease progression at 12 months. Among those for whom their anti-TNF dose remained stable, just 5 percent experienced a flare and only 10 percent showed signs of disease progression. In addition, some people who take an anti-TNF biologic drug develop antibodies to the drug over time, which limits their effectiveness. Antibodies are cells created by your immune system to fight off infections, and if they mistakenly attack anti-TNF drugs, they can cause the drug not to work as well or increase your risk for side effects. That’s why it’s important to monitor your condition and talk to your doctor if you experience any changes in how well your RA is regulated. Because RA is a chronic, or long-term, condition, you should see your rheumatologist frequently anyway — ideally every 3 months or sooner — particularly in the first few months after diagnosis, as you start treatment, according to Mahmood. This can help you establish a long-term partnership with your rheumatologist, and allow them to better monitor your symptoms, check for medication side effects, and perform routine blood tests as well as X-rays and magnetic resonance imaging (MRI), if needed, she says.
Signs You Should Call Your Doctor
Aside from routine visits, Mahmood recommends consulting your rheumatologist if:
You’re experiencing new or worsening symptoms, including joint pain, swelling, or stiffness, especially in the morningYou’ve changed treatment regimens and are experiencing more frequent or severe flaresYou keep getting infectionsYour RA is affecting your ability to go about your day-to-day activitiesYour RA is impacting your quality of lifeYou’re not satisfied with how well your RA is controlled
“Sometimes you may experience other related symptoms, including fatigue or unexpected tiredness, low-grade fevers, dry eyes, or unusual skin rashes,” Mahmood notes.
A Treatment Change May Help
“It’s important that you pay attention to these symptoms, as they may be a sign that your treatment isn’t working as well as it should,” says Mahmood. New or worsening symptoms may also be a sign that your RA is progressing and you need to adjust your treatment. To regain control of your RA, your rheumatologist may:
Adjust your medication doseAdd another medication to your treatment regimenSwitch you to another drug class altogether
It’s Normal to Assess and Reassess Your RA Treatment
It can take some trial and error to find the right treatment or combination of treatments to get your RA under control. Even then, you may have to reassess a previously successful treatment plan if your RA worsens over time. This process is normal for people with the condition, Mahmood explains. “Ultimately, the patient-rheumatologist relationship is long term,” Mahmood explains. “Together, you can learn your ‘normals’ and limitations, create goals, and address problems as they arise so that you can continue to live your best life.”
