At 45, which medicines can help with rheumatoid arthritis?

Question

Hello, Doctor,

I have rheumatoid arthritis at 45. Now, holding a coffee mug in the morning has become painful because my fingers are so stiff. Once I get moving, it improves a little, but the mornings are getting harder every week. I think rheumatoid arthritis damages joints even when the pain isn't severe. I don't always know if I should judge things by how much they hurt or by what is actually happening inside my joints. My medicines seemed to help before, but now I’m not so sure. I do take my medicine on time, but it is not helping me anymore.

Kindly advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Your symptoms suggest your rheumatoid arthritis could be active right now. Active disease is linked not only to increased joint swelling but also to increased pain and morning stiffness. It is important to adjust your treatment as needed because inflammation can cause permanent joint damage over time if it is not quickly brought under control.

This is most likely active rheumatoid arthritis, not just overuse or aging, that is causing your current symptoms.

If you are on Methotrexate but not at the maximum recommended dose, your rheumatologist may increase the dose, gradually, to 25 mg once a week. You may also be prescribed prednisolone 15 mg once daily for around 2 weeks to quickly reduce inflammation and relieve symptoms, then a gradual taper as your condition improves.

If you are already on the maximum dose of methotrexate or your disease is still active despite treatment, it is usually time to consider starting a biologic (biological) disease-modifying antirheumatic drug (DMARD). The majority of patients will begin with an anti-TNF (tumour necrosis factor) biologic and then be re-evaluated at about 3 months to determine whether the drug is effective or a different biologic should be used.

Before you start biologic therapy, you will need to have several screening tests to ensure that it is safe for you to have the treatment. These usually involve

Complete blood count (CBC)
Blood tests for inflammation, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).
Blood tests for liver function.
Blood tests for kidney function (serum creatinine).
Blood tests for hepatitis B (HBsAg) and hepatitis C (HCV antibody).
Blood tests to screen for HIV (human immunodeficiency virus), and blood tests to screen for tuberculosis (either a tuberculin skin test or an interferon gamma release assay).
Chest X-ray and X-rays of your hands to look for any existing joint damage.

Your treatment plan may involve increasing your Methotrexate to 25 mg once weekly, taking Folic acid 5 mg once weekly to reduce side effects of methotrexate, treatment with prednisolone 15 mg once daily for 2 weeks with tapering, and starting a biologic therapy if your disease remains active despite conventional therapy.

You may also be asked to come back to see your rheumatologist about 3 months after starting biologic therapy to see how your symptoms are doing, check your joints, and look at your blood test results to see if the treatment is working well.

You should balance rest with regular physical therapy and gentle range-of-motion exercises, along with medication. During flare-ups, don’t over-stress painful joints but try to stay as active as possible to maintain joint flexibility, muscle strength and overall function.

I hope this information helps you.

Feel free to ask further questions.

Thank you.