February marked the second anniversary of my Rheumatoid Arthritis diagnosis. After two years of treatment, my average pain level was reduced from 10+ to an average range of 4 to 7 every single day. The constant presence of pain and a body riddled with inflammation continue to suck every drop of energy from my aging, aching body.
My treatment was complicated by the addition of thyroid cancer and soon after that with the addition of breast cancer. Both required surgery. Both required radiation treatment. Both required medication. Both interfered with my RA treatment.
- The TNF antagonists, like Embril, are contraindicated for those who have recently had cancer. I am not allowed to have them.
- The ongoing treatment for thyroid cancer is to keep my body slightly hypothyroid. It helps prevent the cancer from recurring but it also increases the effects of RA fatigue.
- The ongoing treatment for breast cancer is anastrosole. It eliminates all estrogen in the body. It also puts me at high risk for osteoporosis as does Rheumatoid Arthritis.
My treatment originally started with methotrexate which did take the edge off, but not enough. Plaquenil, an anti-malarial drug was added next. It became a triple therapy with the addition of sulfasalazine, an old drug designed for rheumatoid arthritis. I am also on meloxicam, one of the safest NSAID’s and low dose prednisone. I have Tramadol and Norco in my arsenal and well as a Medrol pill pack.
I could not tolerate the sulfasalazine, which left me nauseous, queasy, feeling generally rotten. I stopped taking it. Next I was started on Leflunomide, a backup drug for rheumatoid arthritis when other drugs are not working. Additionally, I started injecting my methotrexate. It is easy and safe to do. Still this was not enough.
The consistently elevated inflammation markers in my blood, the constant swelling in my joints, my level of pain and x-rays of my feet that reveal damage collectively paint a picture of RA still out of control. My rheumatologist, my endocrinologist, my oncologist and my internist all agree that Rituxan is next.
It is a drug used for rheumatoid arthritis when all the other drugs have failed. It is only approved by insurance companies when TNF inhibitors have been tried and failed. My doctor sought out and got a special exemption from my insurance company for me since the TNF inhibitors were contraindicated in my situation.
Rituxan is the only drug of its class approved for use with RA in the USA. The drug kills B cells which are produced in excess in RA. It is given in two infusions 15 days apart. Six weeks pass before it takes effect.
Wish me luck! Beyond Rituxan, Orencia might be possible. Otherwise, the magic of the medical world is done. The creeping progression of RA continues.