Free The Autoimmune Connection: Essential Information for Women on Diagnosis, Treatment, and Getting On With Your Life by Rita Baron-Faust, Jill Buyon Page A

myself, “OK! I’m getting better.”
    When the new drugs came out I was in rehearsal for a one-woman show called Tallulah! and my knees blew up. . . . They were extremely painful, so my doctor gave me a new biological drug. I remember it was a Saturday and I injected the medication, and put my legs up and watched over the next four or five hours as my knee swelling went down, and I thought, “OhGod, I’ve got something really good here.” . . . I’m in remission and I know I’m incredibly lucky.
Treating Rheumatoid Arthritis
    In the past 25 years, new medications given early on in the course of disease have made a major difference in the lives of RA patients, boosting life expectancy by a decade to age 86.7, 15 a normal lifespan for most women. Researchers say one of the factors that has led to the decline in RA-related deaths is the use of new medications that reduce inflammation, notably “biological” drugs.
    Treatment usually involves combinations of drugs to attack the disease on several fronts, not only to control symptoms but also to lower disease activity, ideally to put RA into remission and prevent future joint damage. This treatment strategy is called “treat to target.”
    Diagnostic and lab tests can help determine a target (see pages 32 to 33 ), but how you feel and how you function every day are just as important, if not more so, in treatment decisions you and your rheumatologist will make together.
    “The most important outcome for our patient is maintaining function,” says NYU’s Dr. Yusuf Yazici. “But to maintain function, we need to control their pain, the inflammation in the joints, we need to control the swelling. So all our treatments are geared towards making sure the patient at least maintains the function they have, and if we can reverse the disease, sometimes we can improve their function also.”
    The choice of medication takes into consideration a number of factors: whether you have established or “early” RA (symptoms for less than 6 months), how active your disease is, how severe your symptoms are, the proven effectiveness of a drug in similar cases, how a drug is given, how much it costs (including the cost of monitoring its use, such as lab tests), how long it will take to work, and its side effects and risks. Some treatments can contribute to premature cardiovascular disease or cause osteoporosis (see pages 55 to 58 ). If you want to have children, this may restrict your choices, since some medications cause birth defects; you may have to modify your treatment regimen during pregnancy and breastfeeding (see pages 50 to 51 ).

    Ideally, your treatment target should be remission or low disease activity. This is determined by the number of painful and swollen joints (joint counts), the amount of erosion on x-rays, levels of inflammatory blood markers such as C-reactive protein (CRP), and scores on clinical assessment tools you doctor may use. These may include the Disease Activity Score in 28 joints (DAS28), the Clinical Disease Activity Index (CDAI), and the Routine Assessment of Patient Index Data 3 (RAPID3). For example, on the widely used DAS28, remission is defined as a score below 2.6 and low disease activity a score at or above 2.6 to below 3.2. Also taken into consideration are instruments such as the Health Assessment Questionnaire (HAQ), which asks about pain and difficulty in everyday functioning like bathing or getting in and out of bed. These are terms you may see in your medical file.
    To help select the right medications and to monitor your progress, your rheumatologist may refer to guidelines from the American College of Rheumatology (ACR) and/or the European League Against Rheumatism (EULAR). You can read the latest ACR Treatment Guidelines at www.rheumatology.org , under Rheumatoid Arthritis, “Clinical Practice Guidelines” and the EULAR guidelines at www.EULAR.org , under “Recommendations for Management.” These are guidelines only – not hard and fast