I am past due for a RAD update, so here it goes: I had my last appointment with my rheumatologist in June, shortly after I returned from vacation. Since the beginning of March, I've been slowly but steadily improving, with my rheumatoid arthritis symptoms becoming less severe and less frequent. The only real persistent symptom remains my wrists -- they are still weaker than they should be and have a limited range of motion...which may or may not be permanent. However, it is rare now that they hurt on their own, without me putting weight on them or over extending them. This is a big improvement from 6 months ago, where they'd wake me up in the middle of the night and radiate with pain akin to a sprained wrist all day -- I'm assuming that part about the sprained wrist, as I've never actually sprained a bone...just a guess. I get occasional pain in my feet, but it is normally only when I first wake up (morning stiffness), and doesn't usually last very long. I have a few finger joints that still hurt on and off, but not badly, and overall my fingers have had less swelling. And, more recently, I've been able to go down to one dose of naproxen on many days (500mg instead of 1000mg per day).
My doctor had not ordered any labs before my appointment, so he gave me a lab order while I was there, which I got done the next day. Along with my CBC, he tested my ESR or sed rate, as always. I did ask him this time why he always tests ESR and if he ever looks at other biomarkers as an indication of disease activity or inflammation. He informed me that the reason he looks at ESR first is that it's a simpler and less expensive test. Makes sense. If that does not yield helpful results, he will look at other things such as anti-ccp or CRP. Since my sed rate tends to correlate with my symptoms very closely, I suppose there's no need to look at anything else...except to satisfy my own curiosity. As always, I received a phone call from the nurse the day after I got my labs done. Sed rate = 27! Continuing its downward trend, and much closer to the normal range, it looks like my sed rate is continuing to correspond with my symptoms.
So, what's to blame (or, thank, rather) for my decrease in symptoms and lowered sed rate? Well, I'm not really sure. If you look at my chart above, it would seem to indicate that my full three months of Humira combined with an extra kick from Plaquenil got the job done. But did it? I was already starting to feel better when I began taking the Plaquenil. Would I have done just as well without adding it? Or, if I had remained on Enbrel, would the flare have calmed down on its own in due time? Especially since I actually got worse during my first month on Humira? Unfortunately, I don't really know the answers to those questions, as the cyclical nature of rheumatoid arthritis and the multiple variables involved make it difficult to come to a definitive conclusion. Enbrel worked so well for so long and Humira is so similar, that it's difficult for me to believe that everything is thanks to the switch in drugs. But, perhaps it is. RA treatments do tend to become less effective over time, and perhaps a switch was all I needed. Or, perhaps as the chart data suggests, Plaquenil is what really pushed me over the edge and into positive progress.
Whatever the reason, I am feeling better, and it's obvious that this treatment combination is one that works for me. For now. I'm grateful for the pain-free and minimal symptom days, especially during the summer, as I work on my garden and enjoy the usual adventures with Tom!
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