In fact, it’s fairly common to need an occasional change in your treatment plan, whether it’s a switch within a drug class or a step up from non-steroidal anti-inflammatory drugs (NSAIDs) to disease-modifying anti-rheumatic drugs (DMARDs), biologics, or Janus kinase (JAK) inhibitors. Here are six signs that it may be time to talk to your doctor about making a change in your RA treatment:
1. You’re having a flare.
Some people who have RA experience periods in which their symptoms — such as stiff, swollen joints and fatigue — temporarily worsen. This can be due to stress, overexertion, insufficient sleep, illness, or sometimes seemingly no reason at all, according to the Arthritis Foundation. When this happens, your doctor may add corticosteroids — drugs that decrease inflammation — to your treatment plan, or increase the dosage of your current medication.
2. Your medication stops working.
If your RA symptoms start creeping back after a period of being successfully controlled, it could be a sign that your medication isn’t working as well as it once did. Some people simply plateau on a medication after a certain amount of time, while others build up antibodies in their bloodstream that undo the effects of the medication. Be aware that this change can be subtle — symptoms typically don’t return with the same intensity as before you started treatment. “Most people don’t go back to feeling acute pain,” says Elyse Rubenstein, MD, a rheumatologist with Providence St. John’s Health Center in Santa Monica, California. “There’s usually just a slight increase in symptoms.” When medications become less effective, a switch is usually necessary. If you take a DMARD, your doctor may recommend adding a biologic drug — an RA medication that works by interrupting processes in the body that cause inflammation. If you’re already taking a biologic, switching to another type of biologic might be an option. If biologics aren’t helping, your doctor may have you try a newer class of drugs called JAK inhibitors. Work closely with your doctor to settle on the treatment switch that makes the most sense for you. People taking DMARDs are often switched to biologic drugs, which are typically used in people who have more severe RA symptoms, or a JAK inhibitor, which is an option for people who don’t achieve remission with biologics.
4. You’re having trouble adhering to your treatment plan.
When a treatment plan is not well-followed, such as when a dose of medication is skipped, the efficacy of these treatments is severely diminished. This could lead to a flare or even the development new symptoms — which could further frustration, pain, and disease progression and make you less likely to stick to your current plan. If you’re having a hard time remembering to stick with your treatment regimen exactly as prescribed, for whatever reason, it may be time to talk to your doctor about other treatment methods that might be a better fit for your lifestyle.
5. You’re in remission.
If you’re taking RA medication and haven’t experienced any significant symptoms in at least six months, you might be in remission, or a dormant period. A study published in August 2019 in PLoS One found that more than half of people living with RA in remission remained in remission two years later. Those in remission might be able to taper their DMARDs, the study suggested, although some level of treatment was still recommended. Doctors have differing philosophies on how to handle remission, but some recommend changing your medication routine — for example, by stopping one medication if you’re taking a combination of drugs. If you’re taking a biologic medication, you might switch to a DMARD, which typically has fewer risks and side effects. But stopping DMARDs altogether isn’t recommended, even for those in remission. And, though NSAIDs like ibuprofen and naproxen are sometimes used to relieve RA pain, research shows that they don’t prevent joint damage and aren’t an effective stand-alone treatment for RA.
6. You have an infection.
People who take biologics and JAK inhibitors have a higher risk of infection because these medications can lower the body’s immune defenses. According to the Arthritis Foundation, lung complications are the most common symptoms of RA outside of the joints, and taking certain medications can further increase this risk. When serious illnesses like the flu or a bacterial infection occur, doctors usually recommend temporarily stopping disease-modifying medications. “You don’t want to let an infection get out of control,” Dr. Azar says. “It’s much harder to fight off an illness when RA drugs are present.” RA medications are usually resumed after the infection has cleared. Just be sure to work with your doctor if you suspect an infection — don’t adjust your treatment regimen on your own.
Keep Open Lines of Communication With Your Doctor
When you visit your doctor to discuss changes in your RA treatment, thoroughly describe your symptoms and make special note of any new aches or pains you’ve noticed. Be sure to mention if your ability to carry out everyday tasks, like holding a cup or brushing your hair, has become more difficult. Above all, don’t put off seeking help. “Don’t live with pain for long before telling your doctor about it,” Azar says. Remember that checking in with your doctor on the effectiveness, ease, and comfort of your current RA treatment — and if you may need to change it — is the best way to slow disease progression and maintain a high quality of life.
