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Initial Treatment for RA


Whether an individual is seropositive or seronegative rheumatoid arthritis will determine how soon she is diagnosed and what her initial treatment will be.

  • If she is seropositive, she may be diagnosed early in her disease. With a positive RF and anti-CCP antibody test plus joint symptoms a patient may be started on Plaquenil, hydroxychloroquine, a drug originally used for malaria.  It is a mild, effective drug for early RA. As a person with seropositive RA develops increased symptoms, she will probably be started on methotrexate.
  • A patient who is seronegative will need to have an established disease in order to be diagnosed with rheumatoid arthritis.  There is no specific test for seronegative RA.

I had more than ten small, symmetrical, swollen joints, two-month duration, morning stiffness, positive sed rate and positive CRP when I was diagnosed.  

A seronegative RA patient will likely be started on methotrexate in its pill form. By pharmaceutical and medical standards, it is considered safe and effective. It worked about fifty percent for me which is standard. It wasn’t enough but it might be acceptable for someone else.

The methotrexate pills  will gradually be increased to a maximum and optimum dose of 25 mgs a week.  The pills are tiny and come in 2.5 mg tablets so there will be a lot of them. Up to ten. They are supposed to be taken all at once to be effective. Maybe one at a time but consecutively.

 Methotrexate by injection is next when the pills are not enough or when their side effects are not tolerated.  Methotrexate side effects  include nausea and diarrhea. The side effects pass but are very upsetting when they happen. Methotrexate injections avoid the side effects and are more effective.

When  the methotrexate works but is not enough, American rheumatologists will likely add a TNF inhibitor like Humira. European rheumatologists as well as most other rheumatologists in the world might use the triple therapy of methotrexate, hydroxychloroquine, and sulfasalazine first.  It is  cheaper than the RA biologics and is considered effective for some.

This is the start of your RA journey with medical treatment. It will be smooth at times and then it will be frustrating at other times. During it all it is important to remain engaged.

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