How can someone live a daily life with RA at 41?

Question

Hi doctor,

I am completely devastated about my situation. I was diagnosed with rheumatoid arthritis last year, and it has destroyed my normal life. I am a 41-year-old male. My hands are so swollen and painful that I was forced to quit my job seven months ago. The medications, like Methotrexate, have made me feel sick and tired, and I am losing hope of ever getting back to work. My blood tests continue to show high inflammation RF at 110 and anti-CCP antibodies at 135. I am not able to go to work. My ankles and knees are so bad that some days I can hardly walk from my bedroom to the kitchen. My wife has to help me dress and do every simple task. What can I do to regain some control over my life?

Kindly help me.

Thank you.

Answer 1

Welcome to icliniq.com.

I can understand your concern.

In patients with rheumatoid arthritis, Hydroxychloroquine is recommended for initial treatment in those with low disease activity. Methotrexate is recommended for initial treatment of patients with rheumatoid arthritis and moderate or high disease activity. Rheumatoid arthritis treatment should be targeted to a standardized disease activity scale. In patients with rheumatoid arthritis who do not achieve low disease activity with Methotrexate, triple therapy with the addition of Sulfasalazine and Hydroxychloroquine is as effective as adding a biologic or targeted synthetic medication, although response will be slower.

Disease-modifying antirheumatic drugs (DMARDs) are the key to treating rheumatoid arthritis, and timely initiation can prevent joint damage. Although the multiple classes of DMARDs can make treatment decisions challenging, family physicians often prescribe these medications. DMARDs are categorized as conventional synthetic (csDMARDs), biologic (bDMARDs), and targeted synthetic (tsDMARDs).
With low disease activity, initial treatment is with Hydroxychloroquine, Sulfasalazine, Methotrexate, and Leflunomide. Hydroxychloroquine is better tolerated and has a better risk profile than the others. Sulfasalazine is recommended over Methotrexate and Leflunomide because it causes less immunosuppression. Methotrexate is recommended over Leflunomide because of its lower cost and better dosing flexibility.
With moderate to high disease activity, Methotrexate is the best initial treatment for rheumatoid arthritis. Methotrexate has stronger evidence of disease-modifying activity than the other csDMARDs, Hydroxychloroquine and Sulfasalazine. Although some bDMARDs and tsDMARDs have evidence of better outcomes, Methotrexate is safe and effective, with convenient dosing and low cost. Combination therapy is not recommended for initial treatment because it is unnecessary for many patients and incurs higher toxicity and cost.

I suggest you get multidisciplinary team advice. I suggest you consult a rheumatologist, psychiatrist, psychotherapist, and physiotherapist.

I hope I have answered your queries.

Feel free to ask further queries.

Thank you.