I sometimes believe RA patients are divided into two camps. There are those with seropositive disease and there are those with seronegative disease. Those with seropositive disease are treated earlier in their disease. So early that initially hydroxychloroquine might be enough to calm their disease.
In order to be diagnosed with RA, seronegative patients must have more severe disease. Once they are finally diagnosed, they are usually started on methotrexate. An effective, but stronger drug.
My disease started in my feet and was symmetrical. My internist told me my feet were fine. Pulses good. He advised me to put my feet up more. RA in the feet wasn’t really acknowledged at the time. Ten years ago. It was assumed that RA started in the hands. Far easier to examine. Now RA in the feet is commonly seen in most people with RA. It was always there.
About a year later, I developed severe symptoms. In addition to my feet, the joints of my hands, shoulders, elbows, wrists and ankles were inflamed and I was in severe pain. At this point my disease was severe and I was easily diagnosed with seronegative RA. I was started on methotrexate, prednisone as a bridge and meloxicam, an anti-inflammatory drug.
Once the diagnosis is established, the disease runs a similar course and treatment is the same. My disease remained difficult to treat. It was complicated by several cancers and their treatments.
My rheumatologist initially avoided the biologics as they may contribute to the diagnosis of cancer. She eventually prescribed biologic medication. She had tried the four common non-biologics. Methotrexate was the only one that worked but it did not work more than fifty percent. As I said my disease was difficult to treat.
Orencia did work for a year at a time. Presently, I have been on Actemra for ten months. No methotrexate. Low dose Medrol. I’m back on Meloxicam. I use Diclofenac cream as well as Hemp cream. And Lidocaine for my feet at night.
After ten years, my hands are deformed but useable. My feet are numb, so I no longer drive. I am lucky that Actemra works. Without it my options are few and I would be destined to live with endless severe flares.
If you expect to have a diagnosis of RA, do everything in your power to see a rheumatologist as soon as possible. Wait time is up to six months. I talked to a woman who was given an appointment six months out, but she called and called and was finally given a cancellation appointment. She is now on methotrexate and having the side effects, but they will pass, and her disease is being managed.