Question
I’m 46 & in 2002 I began getting pain & stiffness in my joints (fingers, knees, elbows, ankles, etc.) Spent 8 mths w/my GP ruling out causes. All blood work is normal. W/no diagnosis for pain/stiffness, GP referred me to a Rheumatologist; been seeing him about 3-1/2 yrs & feel very unsure of oversight. All tests by RA Dr. came back normal (and still are); he put me on methotrexate & prednisone to see if it helped. It did some but methotrexate made me sick, 6 mths of this, he switched me to Arava. 2 mths later joints were flaring & pain was continuing; he put me on Remicade w/Arava. A yr of Remicade, I reached max dosage & was receiving infusions every 4 wks w/some relief but was not steady state (added methotrexate by injection but this too made me sick). At this point he put me on Enbrel (25mg-2/wk); was feeling pretty good after 2 mths, then switched to new 50mg pre-mix once a wk. Went down hill & after 2 mths was back where I started. My RA Dr. did not believe the medication change was the cause; however, put me back on the 25mg dose. 2 mths later was still having flares so he increased Enbrel to 25mg-4/wk. A yr later I was doing alright but still having pain & occasional flares, so he put me on Humira. Humira made me sick & after 2 mths went back on double dose Enbrel. This is where I am today & am concerned over actions taken. X-rays have never been taken & I don’t feel I’m making the progress I should. A mth ago I asked my RA Dr. about the new meds out & he said he didn’t want to put me on them since they were new, he was only putting his really bad cases on them. Does it sound like I have RA or am I taking meds for something that has not been diagnosed? Do you feel my RA doctor is being proactive or should I seek out another opinion? Don?t know where to turn next. Any advice?
Answer
There is no way anyone can figure this out without seeing you. Even then, it will be extremely difficult if your symptoms are quiet or if your joint exam is normal–one doesn’t know if this is because of the medications or if it is due to the fact that your symptoms resolved. The accurate diagnosis of RA depends on the finding of actively swollen and tender joints. You might seek an opinion at a center such as the Arthritis Center at Hopkins.
