Why is my rheumatoid arthritis worsening despite treatment?

Question

Hello doctor,

I am a 45-year-old woman with rheumatoid arthritis diagnosed three years ago. I am currently on Methotrexate, but my joint pain and morning stiffness seem to be returning. I am worried about long-term joint damage and whether I should consider biologic therapy. How do doctors decide when to escalate treatment, and what are the risks associated with biologics?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Treatment for rheumatoid arthritis is escalated when current medications no longer provide adequate symptom control, especially if signs of ongoing joint inflammation or damage are present. Since you are experiencing a return of joint pain and morning stiffness while on Methotrexate, it is an appropriate time to discuss a change in therapy with your rheumatologist.

Doctors make the decision to escalate based on several factors, including the severity of your symptoms (pain, stiffness, swelling), objective measures of inflammation (blood tests like erythrocyte sedimentation rate and C-reactive protein, evidence of joint damage on imaging (X-rays or ultrasound), and your overall physical function. The goal is to achieve low disease activity or remission to prevent long-term joint damage.

Biologic therapies are often the next step. They target specific parts of the immune system to reduce inflammation. Their risks include a higher chance of infections (due to immune suppression), potential injection or infusion reactions, and a very small associated risk of certain cancers. However, for most patients, the benefit of preventing disabling joint damage far outweighs these risks when monitored properly.

So, you should schedule an appointment with your rheumatologist to reassess your disease activity and discuss options, which may include adjusting your Methotrexate dose, adding another conventional drug, or starting a biologic.

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

Thank you.