Sunday, June 14, 2009

The Four Courses of Rheumatoid Arthritis, part 2

Once you have looked over the four courses which RA can take, you might wonder, so what?

What difference does it make to my treatment? Do I have any influence on which course my RA will take? That is the 64 million dollar question. And the answer is this: MAYBE.

All of the currently used DMARDs have the goal of altering the course of Rheumatoid Arthritis. There is a lot of controversy over whether that is actually possible. The American College of Rheumatology is urging doctors to use more aggressive treatments than were thought necessary only a few years ago.

The goals of treatment are remission, and then a cure. (Stay tuned to RA Warrior for an upcoming post on remissions of RA.) Meanwhile, what does this mean if you are an RA patient? It means get a doctor who wants to access your disease accurately, and then treat you as aggressively as possible, considering your apparent disease course. Tell him/her you don’t want to ride the Tower of Terror!

If you are on courses 3 or 4, and if the DMARDs scare you, try to learn as much as possible about what RA can do to you. That will scare you more! That will probably help you be ready to go on offense.

There is another aspect of this that is difficult. It is unclear what it is that brings about a remission. Usually, it is spontaneous. It is believed that, for some, it has can be brought about by a combination of DMARD medications.

Spontaneous remission tends to make us superstitious. It comes out of the blue. Whatever supplement was tried last is given credit. It is like the way we wear a lucky shirt because it might help the team win. However, none of these things bring actual remissions to people who are in the fourth group. Hmm… I think a real cure would.

What difference does it make to me? How does it impact my life decisions? Knowing more about RA and what course it may be taking can help you to make many other decisions. It always helps to know what to expect.

Here is a short list of decisions to which RA status is relevant:
* Should I have a baby?
* Should I buy a particular house (with hills, stairs, land…)
* Should I change careers?
* Should I live closer to extended family?

One of the worst things about Rheumatoid Arthritis is that we have no idea where it will hit us next. Knowledge will make it less mysterious. Let’s begin today with the big picture. And we will keep learning from there.

Finally, what difference does it make to each other? Some people with Rheumatoid Arthritis get remissions. Some don’t. Some have more permanent damage that continues during remissions. Some have less. Armed with these facts, we can understand one another better and not assume that everyone is like we are. Oh, and, by the way, I’d wear the lucky shirt, anyway.

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