Re: Standard Course of Treatment?

November 12, 2007

Hi Patchouli!

I wondered about the meds too. It might depend on

one's damage to joints and how aggressive the disease

has been? I'm not sure either. I started treatment 2

years ago for this and I'm 35 now (before I was just

being treated for FMS) until they found joint

effusions on both knees, and that I seem to keep

having synovial fluid built up there, and other blood

tests showed it as well.

I started with an NSAID but that did not do it for me.

We tried Prednisone but most of my doctors agree that

is a short term medication to use off and on and not

constantly due to my age and the damage it can do with

bones, etc. Now I take Diclofenac (an NSAID) and then

began with Plaquenil. By the second year that wasn't

enough so we added 3000mgs of Sulfasalazine. We are

now getting ready to add methotrexate. I read this is

quite common approach and was referred to as a triple

therapy combination.

I had to stop the Sulfasalazine and at first I was

glad because it didn't make me feel so great on a

daily basis but helped the pain. Now that I am off it

while I recuperate from bronchitis I can see how much

it must have been helping because the pain is driving

me insane:)

--- Patchouli Sky <patchouli_sky@...> wrote:

> I was diagnosed with RA in September. My GP started

> me on Naproxen,

> then referred me to a rheumatologist. After meeting

> with him, he

> ordered blood tests again (the GP had checked for

> rheumatoid factor

> and other arthritis related blood tests that came up

> negative),

> stopped the Naproxen and started Etodolac. At the

> second meeting with

> the rheumy, he indicated that there was no R factor

> present, but there

> were other indications in the bloodwork, and based

> upon my symptoms,

> RA was diagnosed. He continued the Etodolac, and we

> decided upon

> Sulfasalazine. I'm due for more blood tests and a

> return visit.

>

> After having been here for a few months, I'm

> surprised by the number

> of posters who are immediately put on biologics

> before trying less

> aggressive medications. From my readings, I

> understood that most MD's

> worked up from DMARD's. Another factor is

> insurance. Don't most

> insurance policies require a step up policy in order

> to cover the more

> expensive meds?

>

> Perhaps some of the more sage, experienced fellow

> sufferers could shed

> some light on this for me. It just seems to me that

> meds that carry

> less potentially dangerous side effects should be

> ruled out before

> moving on to the advanced meds.

>

> Thanks.

>

__________________________________________________

November 12, 2007

I saw 3 rheumatologists before settling with my current one, and 2 out of the 3

recommended prednisone + Enbrel. I think several factors were at play in their

drug choices. First of all, I was trying to get pregnant, so that ruled out

mtx. Secondly, I have markers of aggressive RA and I think that justified an

aggressive treatment in their minds. Finally, my attending physician was an RA

and lupus researcher at the NIH, so I think he's a cutting edge guy and

comfortable with biologics. My insurance company at the time didn't balk, so I

consider myself lucky. I have recently switched insurance, so I hope that I

don't run into problems there.

[ ] Standard Course of Treatment?

I was diagnosed with RA in September. My GP started me on Naproxen,

then referred me to a rheumatologist. After meeting with him, he

ordered blood tests again (the GP had checked for rheumatoid factor

and other arthritis related blood tests that came up negative),

stopped the Naproxen and started Etodolac. At the second meeting with

the rheumy, he indicated that there was no R factor present, but there

were other indications in the bloodwork, and based upon my symptoms,

RA was diagnosed. He continued the Etodolac, and we decided upon

Sulfasalazine. I'm due for more blood tests and a return visit.

After having been here for a few months, I'm surprised by the number

of posters who are immediately put on biologics before trying less

aggressive medications. From my readings, I understood that most MD's

worked up from DMARD's. Another factor is insurance. Don't most

insurance policies require a step up policy in order to cover the more

expensive meds?

Perhaps some of the more sage, experienced fellow sufferers could shed

some light on this for me. It just seems to me that meds that carry

less potentially dangerous side effects should be ruled out before

moving on to the advanced meds.

Thanks.

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__________________________________________________

November 12, 2007

Some insurance companies, like mine, require you to fail at two other

DMARD's before they will pay for a biologic. If insurance is not a

factor, maybe some rheumatologists think that a highly aggressive case

calls for the big guns immediately.

Sue

On Monday, November 12, 2007, at 07:45 AM, Patchouli Sky wrote:

> After having been here for a few months, I'm surprised by the number

> of posters who are immediately put on biologics before trying less

> aggressive medications. From my readings, I understood that most MD's

> worked up from DMARD's. Another factor is insurance. Don't most

> insurance policies require a step up policy in order to cover the more

> expensive meds?

November 12, 2007

Assuming that the diagnosis is reasonably certain (and a compelling

argument can be made that RF and anti-CCP-negative disease differs

markedly from RF and anti-CCP-positive disease), rheumatoid arthritis

should be treated as early as possible - and aggressively.

In the past era, physicians recommended conservative treatments such

as rest, aspirin, and NSAIDs first and then slowly worked up to

DMARDs. We have learned from experience and research that this is not

the best approach, especially for aggressive disease.

With that sort of strategy, which was called " the pyramid, " not only

is irreversible damage likely, it is possible that a " window of

opportunity, " during which the very nature of the disease may be

altered, may be missed. The disease may become very difficult to

manage if not hit hard early. Instead of being ahead of the disease,

one may always be trying to catch up to it.

Biologics don't have to be used first, but they do work quickly and

very well for many people. A short course of prednisone plus a

combination of more traditional DMARDs (such as MTX,

hydroxychloroquine, and sulfasalazine) may yield similar results in

early RA.

Some of the most exciting research has shown that some people with

early RA who are treated immediately and aggressively are able to

achieve remission and remain in remission even after the withdrawal of

all treatment. We need to see what happens to these patients in the

years to come, but this phenomenon has important implications.

In the future, it could be demonstrated that biologics used as

first-line treatment may be cost-effective, particularly if they can

be withdrawn relatively soon and the disease remains in remission.

Untreated or undertreated rheumatoid arthritis also has associated

risks and costs - more office visits, more tests, more

hospitalizations, more joint replacements, heart attacks, and other

complications. Such consequences have a profound effect not only on

the wallet but also on the quality of life of the patient.

Not an MD

On Nov 12, 2007 6:45 AM, Patchouli Sky <patchouli_sky@...> wrote:

> I was diagnosed with RA in September. My GP started me on Naproxen,

> then referred me to a rheumatologist. After meeting with him, he

> ordered blood tests again (the GP had checked for rheumatoid factor

> and other arthritis related blood tests that came up negative),

> stopped the Naproxen and started Etodolac. At the second meeting with

> the rheumy, he indicated that there was no R factor present, but there

> were other indications in the bloodwork, and based upon my symptoms,

> RA was diagnosed. He continued the Etodolac, and we decided upon

> Sulfasalazine. I'm due for more blood tests and a return visit.

>

> After having been here for a few months, I'm surprised by the number

> of posters who are immediately put on biologics before trying less

> aggressive medications. From my readings, I understood that most MD's

> worked up from DMARD's. Another factor is insurance. Don't most

> insurance policies require a step up policy in order to cover the more

> expensive meds?

>

> Perhaps some of the more sage, experienced fellow sufferers could shed

> some light on this for me. It just seems to me that meds that carry

> less potentially dangerous side effects should be ruled out before

> moving on to the advanced meds.

>

> Thanks.

November 13, 2007

My mom has Cigna and loves it. She has never had problems. Her co-pays and

such and less than half of what mine are. Then again her husband is in a

union and this is the insurance they have negociated and it is probably some of

the best in the country!! LOL I just think my hubby's company are cheap and

picked a crappy plan just to say they have insurance.

To make matters worst I live in a small area with limited resources and one

medical center that creates a big monoply. They convinced Cigna to cancel all

the contracts with all other medical providers and go with them exclusively.

Then they proceeded to bill the heck out of me!!!!!! I still owe them LOTS

of money which I will probably never be able to afford to pay.

So a year into this mess Cigna created they got a contract back with the

small medical center I use to go to. So I am going back to them. Its still

expensive. But I guess what can you do. I have taken a different approach with

my

docs. They refused to fill out my paperwork so I got my LTD terminated a

month ago. So my approach is...as long as you prescribe some drug that is cheap

$5 co-pay or less I can have it...more than that..I can not afford it since you

refused to fill out paperwork.

I tell them straight up...no money no meds....no money no doc visits. They

are not happy about it...but quite frankly I don't think they really care.