Coming up with a treatment plan
Your rheumatologist or other health professional will usually come up with your treatment plan based on the current RA treatment guidelines. These guidelines are published by the American College of Rheumatology (ACR), the professional association of rheumatologists in the U.S. If you want to learn more about how these guidelines came to be and how they are used you can learn more about this on our RA treatment guidelines page.
Signs of inflammation/inflammatory markers
There are signs of inflammation in your blood that your doctor can test. These test results can show how active your disease is and how well your treatments are working. These are often called inflammatory markers. You should know that not everyone’s markers correlate with their disease activity. You may be having pain and swelling while these markers look normal or vice versa:
- Erythrocyte sedimentation rate (ESR) or “sed rate”
- C-reactive protein or CRP
Your blood may also have other “markers” that show up as a positive result on tests. Not everyone with RA tests positive for these markers. You may hear your doctor refer to this as “seronegative” rheumatoid arthritis. But if you do test positive for these markers, they may remain in your blood even if your RA goes into remission after treatment:
- Rheumatoid factor or RF (not everyone who has a + RF has rheumatoid arthritis)
- Anti-cyclic citrullinated peptide proteins or “anti-CCP”
Different doctors use different scoring systems to measure your disease activity and check your progress, such as DAS 28, CDAI, SDAI, and RAPID3. These scores may look at different test results or physical exam results, but they’re all based on specific measures. Using these scoring methods can be helpful to your doctor in determining if you are responding to treatment.
Low disease activity, or remission, is the goal for your RA treatment plan. The various scoring methods look at your lab test results, a count of your tender or swollen joints, and how well you’re able to function on a daily basis, and can help your doctor determine if you are in a low disease or remission state. We’ll talk about remission more later. It doesn’t mean you should stop taking your RA drugs, but you may be able to take lower dosages or take fewer drugs after talking with your doctor.
Your treatment plan will depend on your disease activity score and other factors such as:
- Joint or organ damage
- Other diseases you have, such as liver or lung disease
- Possible reasons that the drug could do you harm and mean you should avoid it
- Your personal preferences, such as drugs that are taken as pills or injections
Based on these factors, your doctor and you may choose to start you on just one drug, which is called monotherapy, or a combination of two or three drugs, called “double therapy” or “triple therapy.”
Side effects are changes that can occur in our bodies as the result of using a particular medication or device. Side effects can be mild or severe and can vary greatly from person to person.
Rheumatoid arthritis comorbidities
A comorbidity is a condition you have at the same time as your primary condition. Many people with RA have one or more of four common comorbidities: chronic respiratory conditions, diabetes, heart disease, and stroke. This might be a result of the inflammation in RA or because RA can lead to decreased mobility, which can increase the risk of these other health problems.
Rheumatoid arthritis contraindications
Contraindications are situations when you should avoid taking a certain medication for health reasons. For example, you should not take DMARD therapy (an RA medication that slows down the progression of your disease. DMARD stands for disease-modifying antirheumatic drug) if you are pregnant; have alcoholism; have alcoholic liver disease or other severe chronic liver disease; have immunodeficiency syndromes such as HIV/AIDS (some patients with HIV can take DMARDS and biologics under careful monitoring), in which your immune system is not working properly (overt or laboratory evidence); or have pre-existing blood dyscrasias (for example, bone marrow hypoplasia, leukopenia, thrombocytopenia, or significant anemia).
If you have active hepatitis A, B, or C, you will need to be treated for that by a liver specialist before you take any drugs for your RA that suppress your immune system or affect your liver. Your liver specialist and rheumatologist can both decide, if once your hepatitis is either stabilized or being treated, that you can start to take certain medications for your RA. But you’ll need to be monitored closely. You may need to come in for blood tests often.
If you have had a previously treated skin cancer, make sure that you are followed closely by your dermatologist as certain RA medication can increase the risk of certain types of skin cancer.
If you have had a previously treated lymphoproliferative disorder, or cancer of any type, you will need to speak with your rheumatologist, as certain RA medications may be better to use in that case. Your rheumatologist may want to speak with your oncologist to figure out the best medication for you.
For more information about existing medications for rheumatoid arthritis and how they work, read our section on RA medication.