Is there a new therapy for my mother's rheumatoid arthritis?

Question

Hello doctor,

My mom, who is 58, was diagnosed with rheumatoid arthritis about two years ago. Lately, her joint pain has gotten worse, especially in the mornings, she says her hands feel stiff and swollen for hours. She is on Methotrexate and was doing okay for a while, but now it feels like the medicines are not helping much. She is also feeling really tired, and even simple things like opening a jar are hard.

We are wondering if her medication needs to be changed or if this is just how the disease progresses.
Are there newer treatments out there that can work better for her?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I truly understand your concern for your mother. Rheumatoid arthritis (RA) can be a challenging condition, especially when symptoms worsen despite ongoing treatment.

From what you have described, increasing morning stiffness, persistent joint pain, swelling, and fatigue, likely, her disease is not well-controlled at the moment. While Methotrexate is often the first-line therapy for RA, over time, it may become less effective for some individuals, or it may not be strong enough alone to manage active disease.

Here is what you should know:

This is not necessarily just how RA progresses. Worsening symptoms while on treatment can indicate the need for a change in her management plan.
Newer treatment options are available, and many people benefit from adding or switching to a biologic disease-modifying antirheumatic drug (DMARD) or a targeted synthetic disease-modifying antirheumatic drug. These include biologics such as Adalimumab, Etanercept, Tocilizumab, or Abatacept, and Janus kinase (JAK) inhibitors like Tofacitinib or Upadacitinib are oral medications.
Combination therapy is also common. Methotrexate may be continued alongside a biologic to enhance effectiveness.
Fatigue and functional decline are often signs of uncontrolled inflammation, but they could also indicate other factors like anemia, thyroid disorders, or medication side effects, which her doctor might also check.

I would suggest the following:

Schedule a follow-up with her rheumatologist to reassess her current disease activity and possibly adjust her treatment.
Discuss whether she is eligible for advanced therapies or clinical trials in your area.
Encourage her to continue gentle physical activity, as joint-friendly movement can help preserve function and reduce stiffness.
Consider seeing an occupational therapist to help with daily tasks like opening jars or buttoning clothes.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.