For people with arthritis, switching medications is almost as common as switching partners on The Bachelor — you just have to keep going until you find what works best for you. And even when you think you’ve found The One, you may discover that it it’s not a long-term fit — maybe it has started to cause side effects or isn’t managing your symptoms as well as it used to.
Trial and error to find the right medication for your arthritis can be one of the most frustrating parts of having an already incredibly frustrating disease. (Although at least you won’t have to publicly contemplate marriage to a virtual stranger on national television?)
Understanding Arthritis Medication Options and Changes
Unlike decades ago when our understanding of the causes and progression of arthritis was more limited and medication options were far fewer, today we have more choices than ever to treat different types of arthritis. This is especially the case for inflammatory types of arthritis such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, which have many classes of drugs, each with different “mechanisms of actions” — or the specific ways they work in your body to treat your disease.
While this means that you don’t need to settle for a treatment that isn’t helping you feel better, it also means you’re more likely to experience medication stops and starts along your treatment journey. “Every patient is different, every disease is different, and every medication is different so there are a lot of variables we are working with,” says Elyse Rubenstein, MD, a rheumatologist at Providence Saint John’s Health Center in Santa Monica, California. “Don’t be surprised if you have to change treatments. It’s very, very common.”
There are many reasons that might trigger a medication switch, she says. These include:
- You feel like the medication is not controlling your symptoms or is only working for some of your symptoms, so you’re not getting the relief you need to function in your daily life.
- The medication method and/or schedule doesn’t work with your lifestyle.
- Side effects, for you, are so bad that they outweigh the good.
- Medication that used to work well is no longer working.
- Medication interferes with a different part of your treatment.
Autoimmune and inflammatory diseases are rarely straightforward — treating them is isn’t as simple as, say, prescribing blood pressure medication to someone with hypertension — so there will be more trial and error. In addition, all of these factors are amplified when you have more than one chronic illness that needs to be managed, and it’s very common for people with arthritis to have multiple chronic diseases at the same time.
How Do You Know When to Switch Medications?
The short answer: Consider a medication change if you are unable to reasonably function in your daily life and/or you have high levels of chronic pain. If that sounds a little subjective, that’s because it is. This is why constant and honest communication with your doctors is the best thing you can do in regards to ensuring you’re on the right medications, Dr. Rubenstein says. Here are more signs you should consider discussing an arthritis medication change with your doctor.
Tips for Starting a New Arthritis Medication
Keep a symptom journal
Allanah M., 22, of Atlanta Georgia, estimates she’s been on more 15 different medications since being diagnosed with inflammatory arthritis and Sjögren’s syndrome. “Some of the best advice I got was to keep a daily symptom journal,” she says. “I write down when I start each drug, the dosage, and then track my mood, pain, side effects, and other physical symptoms.” This has helped her to see that some medications she thought weren’t helping were actually making a difference. Her journal has also helped Allanah and her doctor see when things clearly weren’t working, she adds.
You can also track your medications with ArthritisPower, CreakyJoints’ patient-centered research registry. Log your medications to track side effects and impact on disease activity. Learn more and sign up here.
The more knowledgeable you are about your treatments, the better prepared you’ll be to take them in the right way and the more prepared you will be for potential side effects. “With each new medication be sure to ask about how long it will take to feel the effects, how long it takes for the drug to reach full effect, the proper dosing schedule, common side effects to watch for, and how often to come back for check-ins,” Dr. Rubinstein says.
Many of the medications prescribed for arthritis take a long time to take full effect, Dr. Rubenstein says. How long? Prescription NSAIDs should offer some relief within an hour but they need to be taken for a week to feel the full effect; conventional DMARDs like methotrexate begin to help within four to six weeks but you need to give them three months before you deciding if they’re helping; biologics (both infused and injected) may start to make a difference within a couple of weeks, but they also take up to three months to provide symptom relief, she says.
Take your meds exactly as prescribed
Your new medication will not work as it should if you don’t take it properly and on schedule. There are many tricks for remembering to take your medication but the important part is to have some kind of system that works for you, Dr. Rubenstein says. “Find a way to work your meds into your lifestyle so you’re consistent,” she says. This could include setting an alarm on your phone or adding it to a part of your established routine, such as right after brushing your teeth, so you make taking the medication a habit.
Don’t stop taking the new meds once you start to feel better
One of the most common mistakes patients make when starting a new medication is taking it randomly or quitting it once they start to feel better. “Rheumatic diseases tend to be chronic and so medications must be taken even when the patient feels well,” says Ashira Blazer, MD, a rheumatologist and assistant professor of medicine at NYU Langone Health in New York City. “Lapses during the good times may make it seem like the medication is not working when it is and can make it difficult to achieve the same level of efficacy once the drug is restarted.”
Don’t ignore or minimize side effects
When Alannah started a new medication she noticed some stomach pain and nausea but she was determined to “not be a wuss” and tried to push through the pain. “Eventually I got to wear I just couldn’t swallow my pills. I couldn’t even look at them without gagging,” she says. When she finally told her doctor, he immediately switched her to a different drug in the same class of medications and her stomach symptoms went away almost immediately. “I wish I’d brought it up sooner, I could have saved myself so much pain,” she says.
Ask about formulation options
Pills are generally known to cause stomach upset compared with other formulations, so if you’re prone to those symptoms, ask if there is an injectable or topical version of a medication you can use instead, says Aly Cohen, MD, a rheumatologist at Integrative Rheumatology Associates in Princeton, New Jersey, and founder of The Smart Human. “Pills have to pass through the entire gastrointestinal tract but using an intramuscular injection often allows us to use less medication as it goes directly to your bloodstream, which can lessen side effects,” she explains. Methotrexate is a good example. Injections may be a better option for patients who experience GI side effects from pills.
Understand your arthritis symptoms and what this medication will do for them
Not all arthritis medications are meant to manage every symptom. Some work primarily to bring down inflammation and swelling; others are meant to reduce pain. Understanding the different aspects and symptoms of your type of arthritis and what exactly this new medication is supposed to treat will help you gauge whether or not it’s working as it’s supposed to.
Manage your expectations
“There isn’t one ‘magic bullet’ that will fix everything,” Dr. Rubenstein says. How well you respond to a medication depends on many things including your age, disease progression, comorbid conditions, support from your health care team or loved ones, how well you adhere to your medication, and many other variables. What worked great for your friend may not be the right answer for you. You’re looking for something that will help you be functional and feel better, not necessarily something that will make you forget you even have arthritis.
Make your ‘med check’ appointments in advance
Since recently starting a biologic for her rheumatoid arthritis, Sarah P., 35, of Rochester, New York, needs monthly “med checks” to make sure the meds are working properly. But while she knows these follow-up appointments are important, they often slip her mind. “Now I make my next three med check appointments before I leave the office,” she says. “I put them in my phone calendar so I can’t forget.”
Try folic acid for methotrexate side effects
Methotrexate is one of the first-line drugs used to treat many types of arthritis and doctors are very familiar with helping patients manage its side effects. The one Dr. Rubenstein hears the most from people first starting it are GI symptoms like nausea, stomach aches, and heartburn. One thing that does seem to have a significant improvement is taking a daily folic acid supplement, she says. Talk to your doctor about which type and how much folic acid you need. Read more about why folic acid is important to take when you’re on methotrexate.
Get a flu shot if you’re starting a biologic
Biologic medications, both infused and injected, work by suppressing your immune system. One thing you can do to strengthen your immune system is to make sure you’re current with your immunizations and, depending on the time of year, get a flu shot, says Orrin Troum, MD, a rheumatologist at Providence Saint John’s Health Center in Santa Monica and on the faculty at the Keck School of Medicine at University of Southern California. Even better, ask anyone who lives or works closely with you to also get a flu shot to help avoid spreading it to you.
Don’t rely solely on your medication to make you feel better
Living a healthy lifestyle is one of the best things you can do when starting a new medication, says Anca Askanase, MD, a rheumatologist and director of rheumatology clinical trials at Columbia University Medical Center. Medications can help treat symptoms and prevent long-term disease progression, but they’re more effective when you also have healthy lifestyle habits, such as losing weight if you need to, eating nutritious foods and minimizing processed foods, getting regular physical activity, and doing activities to reduce stress.
Discuss, don’t demand
“Ultimately it should be your physician who advises when a medication switch is necessary, as we understand the intricacies of the drugs and your illness,” Dr. Rubenstein says. It’s fine for you to bring up your concerns, ask questions, and even reference a drug you saw advertised somewhere, but at the end of the day you need to trust your doctor, she says.
If you think your doctor isn’t fully understanding your concerns or motivations for seeking a change in treatment, that’s a different story — you may need to consider a second opinion from a different provider. Check out these signs that you’re seeing the right rheumatologist for your health needs.