Patient's Query
Hello doctor,
I am 43 and was diagnosed with rheumatoid arthritis two years ago, but have trouble finding treatment that works.
I started on Methotrexate 20 mg weekly with folic acid, but my liver enzymes elevated after six months. Then I switched to Hydroxychloroquine, but there was no improvement in my joint pain or swelling. Now I have been on Sulfasalazine 2000 mg daily for four months, but I am still having terrible morning stiffness lasting over two hours.
My hands are so swollen that I cannot make a fist and cannot wear my wedding ring anymore. My rheumatoid arthritis mainly affects my hands, wrists, and feet.
My rheumatoid factor is high at 187, and CCP (cyclic citrullinated peptide) antibodies are over 250, ESR (erythrocyte sedimentation rate) is 67, and CRP (C-reactive protein) is 45. My rheumatologist wants to start biologic therapy, but I am worried about infection risks.
I work as a nurse in a hospital and am already exposed to germs constantly. Also concerned about cost because biologics are expensive. Having rheumatoid arthritis at my age is depressing; I feel too young to be this disabled.
Is there a way to predict if a biologic will work before starting it?
I really need something effective because the pain is unbearable.
Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I have read your query, and I am really sorry that you are going through such a painful and discouraging experience. Living with rheumatoid arthritis (a chronic autoimmune disease where the immune system mistakenly attacks the joint lining, causing painful inflammation, swelling, stiffness, and potential joint damage, often affecting hands, wrists, and feet) at a young age can be physically and emotionally exhausting, especially when treatments do not seem to bring relief.
From what you described, your disease activity remains high despite trying multiple conventional medications, which means it is considered an inadequate response to traditional disease-modifying drugs. In such cases, moving to biologic therapy is a reasonable next step and is often the most effective option for people whose symptoms remain uncontrolled.
Biologic drugs such as Adalimumab, Etanercept, Infliximab, or newer options like Tocilizumab and Abatacept are designed to target specific parts of the immune system that drive inflammation. While it is not possible to predict with certainty which biologic will work best for a particular person, rheumatologists often make the choice based on individual disease features, lab results, and previous medication responses.
Some studies suggest that people with very high levels of inflammatory markers or antibodies like CCP (cyclic citrullinated peptide) and rheumatoid factor, as you have, may respond well to biologics that target tumor necrosis factor (TNF, a potent immune system messenger, primarily a pro-inflammatory cytokine that plays a critical and complex role in a wide range of biological processes) or interleukin pathways. However, the response varies from person to person, and sometimes it takes trying one or two different agents to find the one that works best.
Your concern about infection risk is very valid, especially since you work in a hospital environment. Biologics can slightly increase susceptibility to certain infections, but your doctor can help minimize risk by screening for tuberculosis (a preventable and curable bacterial infection that typically affects the lungs but can impact other organs, spreading through the air when an infected person coughs or sneezes) and hepatitis (inflammation of the liver, most commonly caused by a viral infection) before treatment and by ensuring that you are up to date on vaccines.
Practicing good hand hygiene and wearing protective equipment, which you already do at work, are also helpful preventive steps. The benefits of improved function, reduced pain, and prevention of joint damage often outweigh the risks for most patients, especially when symptoms are as severe as yours.
Cost can be a serious issue with biologic drugs, but many pharmaceutical companies and insurance programs offer financial assistance or patient support plans. It is worth discussing these options with your rheumatologist or a hospital social worker before starting treatment.
I hope this answers your query.
Please let me know if I can assist you further.
Thank you.
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