When it comes to treating rheumatoid arthritis (RA), you and your doctor have more options than ever before. If one medication doesn’t work, you can try another.
Right now, there’s no way to predict how you’ll do on any particular therapy. Sometimes, your body never responds to a treatment at all. In other cases, a drug might work for a while and then stop. Your doctor will monitor several of the following signs. If he or she spots worsening trends over time, it may be time to change tactics.
1. Your Disease Activity Score Rises
A hands-on approach helps your doctor determine what’s happening under the surface. He or she will examine your body, tallying the number of tender and swollen joints. You may hear the result called your “disease activity score,” or DAS.
Your doctor notes this number in your charts. If it decreases, your treatment is probably working. But if it increases or stays the same for a while, your doctor may consider trying a different treatment. Between visits, you can track disease activity yourself using a smartphone app or other tool.
2. You Feel Worse
Your arthritis may flare from time to time, even during successful treatment. But if you develop increasing joint pain and stiffness, or have more trouble than usual when performing everyday activities, you may require a change.
Some doctors will ask how you’re doing. Others ask you to fill out a detailed questionnaire. You’ll rank your pain and report difficulties with chores like bathing and dressing. These surveys, including one called the RAPID3, typically provide you and your doctor with another number to track over time.
3. You Develop Antibodies
Powerful medications called anti-TNF inhibitors—including prescribed Remicade (infliximab) or Simponi (golimumab)—halt inflammation in your joints. This slows the progress of your disease.
But sometimes, your body mistakes these medications for foreign invaders. Your immune system develops antibodies that attack the drug. This response interferes with your treatment and increases your risk for side effects. Your doctor can do a blood test to detect these antibodies. If they’re present, another therapy may work better for you.
4. Your Polyglutamate Levels Are High
One of the most commonly used medications for RA, methotrexate (Rheumatrex or Trexall), works by slowing your immune system’s attack on your joints. Once you swallow a methotrexate tablet, the drug enters your cells. There, your body converts it to compounds called methotrexate polyglutamates. If this conversion doesn’t occur, the medication can’t fight your disease.
It takes a few months for methotrexate to have an effect. Three months after you begin therapy, your doctor may measure your blood polyglutamate levels to see if the drug is working. If they’re low, methotrexate might not be your best choice.
5. Your Blood Shows Signs of Inflammation
When inflammation from RA damages your joints and muscles, the tissues release telltale markers into your bloodstream. Your doctor can test for these chemicals, which include enzymes known as creatine phosphokinase (CPK) and aldolase.
Another blood test, the erythrocyte sedimentation rate, also measures inflammation. In fact, your doctor may have used it to help diagnose you with RA. It provides your sedimentation “sed" rate, or how quickly your red blood cells adhere to each other. The faster they cling, the more inflamed your joints—meaning your treatment isn’t successfully soothing RA’s pain and swelling.
If your “disease activity score,” or DAS, increases or stays the same for a while, your doctor may suggest a different treatment.
Anti-TNF inhibitors halt inflammation in your joints, but your immune system may develop antibodies that attack the drug, interfering with your treatment.
If you take methotrexate and your doctor finds that your blood polyglutamate levels are low, it might not be the right medication for you.