How can women deal with severe joint pain due to RA at 58?

Question

Hi doctor,

I am a 58-year-old female with a five-year history of rheumatoid arthritis. I was initially treated with Tablet Sulfasalazine but switched to Tofacitinib due to insufficient response. My most recent lab results show a negative rheumatoid factor, but my anti-cyclic citrullinated peptide (anti-CCP) is still positive, and I have an elevated erythrocyte sedimentation rate (ESR) (35 mm/hr), indicating active inflammation. I also have hypertension and take medication for that. Recently, I have noticed increased joint pain and some new swelling in my elbows, which I have not experienced before. I am worried about the effectiveness of my current treatment and whether I should consider switching medications again. Additionally, I have heard about potential cardiovascular risks associated with rheumatoid arthritis (RA) and would like to know how my overall health might be affected. What steps should I take to manage these new symptom,s and what are my options for moving forward?

Kindly help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Firstly, your switch to Tofacitinib from Sulfasalazine was given its role as a Janus kinase inhibitor (JAK inhibitor), which is prescribed when there is an insufficient response to Sulfasalazine. Persistent symptoms of active inflammation due to high erythrocyte sedimentation rate (ESR) and the recent joint pain and swelling require reassessment of the treatment plan.

A positive anti-cyclic citrullinated peptide (anti-CCP), even with a negative rheumatoid factor, suggests active autoimmunity. Your new symptoms, increased joint pain, and swelling in your elbows indicate that either your rheumatoid arthritis (RA) has flared up or your current medication is not achieving full control. I suggest the following options:

1. One option is to increase the dose of Tablet Tofacitinib if you are on a lower dose, provided your doctor agrees, considering your hypertension. If an increase in tablet Tofacitinib is not advisable, you may switch to a tumor necrosis factor (TNF) inhibitor, an Interleukin 6 (IL-6) inhibitor, or an alternative called a Janus kinase (JAK) inhibitor.

Each of these targets different pathways of inflammation.

2. Another option is adding Methotrexate or combination therapy.

A physical examination by a rheumatologist is necessary.

RA patients have a higher risk of cardiovascular issues, especially when inflammation is active.

Persistently elevated ESR can contribute to arterial inflammation, which in turn may increase the risk of heart disease.

I also suggest you do the following:

Tablet Tofacitinib may cause increased cardiovascular risks in patients with hypertension. Make sure your blood pressure is well-controlled.
Regular exercise, a balanced diet, and avoiding smoking are very important.
Gentle stretching and low-impact exercises can ease joint stiffness and improve flexibility without putting too much strain on your joints.
Anti-inflammatory foods can also be beneficial.

Get well soon, and feel free to follow up with any questions or concerns.

Thank you and take care.