I have started allopathy treatment for my rheumatoid arthritis. What to expect now ?

Rheumatoid arthritis is a painful and complex disease. The patients of RA are already in pain. They also have a lot of anxiety while first starting their treatment.

Many patients don’t trust allopathy for treatment of their Rheumatoid arthritis. This is especially true in developing countries like India.

We have outlined before about why one should not rely on ayurveda, homeopathy or natural therapies to treat rheumatoid arthritis. The links for same can be found in article links given just below.

What is the best & natural way to treat Rheumatoid arthritis without side effects of allopathy drugs ?

Should I try Ayurveda for curing my rheumatoid arthritis ?

Now suppose a patient (or you) have already decided to start allopathy treatment for RA. Such patient should know how their medications for rheumatoid arthritis are going to be adjusted in coming weeks or months.

What should one expect when they start Rheumatoid arthritis allopathy treatment

Get educated about your disease. That is simple most important thing a patient can do to help themselves. The more educated one is about their disease, the more rational decisions they can make. Ask for reliable sources to read from your doctor. Don’t read random Google articles.

You can read for more information on rheumatoid arthritis on following links below.

Rheumatoid Arthritis – Basics for Patient

What is Rheumatology & arthritis ? Who is a Rheumatologist?

How to have realistic expectations of treatment ? Rheumatoid disease treatment may take some time to work.

Don’t expect complete pain relief in days or weeks. Most rheumatologist doctors will start with a bit of steroids and anti-inflammatories (NSAIDS, better known as pain-killers) to initially control the disease. They might also start DMARDs (disease modifying anti-rheumatic drugs) like methotrexate or leflunomide or sulfasalazine or hydroxychloroquine or biologics along with it. Please understand that most of above drugs may take 6-12 weeks for maximum effect.

Consider this analogy – When we start rheumatoid arthritis treatment, the disease is like hot iron. We have to hit hard to give shape to the disease (or bring it in control). Once we get desired shape of iron, we stop hitting hard and maintain things with other drugs. So initially, we have to use drugs like steroids and anti-inflammatories to bring disease under rapid control. We also start other drugs which act a bit slowly. Slowly we decrease, later stop steroids and anti-inflammatories (painkillers) in most cases. Then we maintain RA control on other drugs. That is why a RA patient may have to take more pills at start.

For more information on why Rheumatologists use steroids to treat RA, please read the article below
Why do Rheumatologists use steroids to treat Rheumatoid Arthritis ?

Rheumatologists usually use step up treatment for rheumatoid arthritis and re-evaluate things every 3-6 weeks at start

As rheumatologist start treatment for rheumatoid arthritis, they will check how the patient is every 3-6 weeks. If the patients disease is not controlled and all other things are good, they will increase the treatment or dose and recheck after 3-6 weeks. After every increase in treatment doctors have to wait for 3-6 weeks before deciding on whether we have to escalate further.

I always tell patients this analogy or example. Consider that we are climbing a building for rheumatoid arthritis treatment. We will first go to one floor and see if patient has reached destination. If we haven’t controlled the disease than only we will go to second floor. At each floor (after each treatment increase) we usually wait for 3-4 weeks for drugs to have maximum effect. Thereafter we decide on further course.

How well do patient respond to initial treatment of rheumatoid arthritis ?

50-75 percent of Rheumatoid arthritis patients do well on initial standard of care treatment (it might obviously vary with what drug is being used to treat). In countries like India this initial treatment is very low cost and effective. We usually start patients on two disease modifying anti-rheumatic drugs (DMARDs) to control their Rheumatoid arthritis. Such patients usually achieve good control in around 6-8 weeks.
Around 20 percent patients require more low cost tablets (DMARDS) and their disease can be controlled with these tablets. These patients may take around 12-16 weeks to get controlled.
Around 20 percent patients have very severe disease to start with and they may be counselled to taking relatively expensive drugs (Indian context) – biologics or biologics like which can control disease very fast and effectively. We might also need to use biologics right at start in patients with very severe disease.

How many tablets do I have to take daily while taking treatment for rheumatoid arthritis ?

Usually 50-70 percent patients are very well controlled on 2-4 tablets per day. 1-2 of them are weekly tablets (eg methotrexate, sometimes folic acid and leflunomide). As disease gets very well controlled we can possibly taper to weekly tablets in most of well controlled patients.

Around 20 – 40 percent patients require additional tablets and may be on 2-3 tablets per day depending on severity.

When we use biologics, they are given as weekly/ fortnightly / monthly or 2-6 monthly injections. They can be very helpful in decreasing the daily pill requirement.

Can we decrease medications for rheumatoid arthritis in long run ?

Yes certainly in many. The patients who start treatment early and follow their rheumatologists advice thoroughly usually do very well in long run. The faster the disease is brought under control, the patient has less or no damage to joints. Also, once patient is under persistent control we can decrease many medications and keep patients under control on minimum drugs. In few percentage of patients we can also stop drugs. But remember early and tight control of the disease is very important.

To summarise on things to know when one is starting Rheumatoid arthritis treatment

• • The allopathy treatment of rheumatoid arthritis is very effective and can give a great quality of life to patients with this troubling disease
  • RA is a very complex disease and treatment can be complex. Qualified Rheumatologists are best people to show for same.
  • Severe RA may require intense treatment at start with multiple medications. We might have to use steroids at start which are gradually stopped once patient achieves control of disease and same can be maintained with other drugs.
  • 50-75 percent patients of RA achieve good control with basic low cost drugs and achieve disease control in 6-12 weeks. However ones with more severe disease, may require longer time for good control of the disease.
  • If a particular medication doesn’t suit to the patient, they should go to their doctor and talk about it. There are more than 10 options to treat rheumatoid arthritis now. One shouldn’t doubt allopathy treatment and their specialist in case they don’t respond initially or medications don’t suit them.
  • The goal of RA treatment is to achieve absolute disease control or remission (no inflamed joints – near silence of the disease). The rheumatologist may need to step up or change therapy every 4-6 weeks if this goal is not achieved. Many rheumatology medications are slow to act and it might take 6-12 weeks or sometimes even more to achieve.

Biologic drugs can be very useful to achieve very good control of RA early. They decrease the requirement of steroids. They can achieve much faster control at times. They are recommended if conventional treatment fails and if the disease is very aggressive.

Do let us know your experience and feel free to contact us with queries.