RA is an autoimmune inflammatory disease meaning that your immune system attacks itself causing inflammation resulting in pain, heat, swelling, fatigue, malaise, and permanent joint destruction (described in an earlier blog post ). Historically, medical treatments against RA are designed to reduce inflammation. I will use a war analogy to describe this battle, discuss the weapons used, and describe some of the battle scars I’ve experienced thus far. This war against inflammation is multifaceted and anyone diagnosed with RA long enough will likely experience most of the weapons from the doctor’s arsenal. Here’s how I categorize the weapons using military terminology.
Conventional – NSAIDs
Nuclear – Steroids
Chemical – Methotrexate and others
Biochemical – biological drugs
Natural – diet
In this post, I will start with conventional weapons. Subsequent posts will systematically address the other categories.
I liken non-steroidal anti-inflammatory drugs ( NSAIDs) to conventional weapons. Thousands of years ago it was noticed that chewing on the bark of willow trees reduced fever and pain. Aspirin was eventually developed in the 1800s and it is now the most widely used medicine in the world. Many other chemicals over the years joined the conventional weapon arsenal including ibuprofen, naproxen, celebrex, and vioxx (removed from the market). NSAIDs work by inhibiting enzymes that promote inflammation. They have provided much relief for many arthritis sufferers over the years. But if taken over long periods of time for chronic pain, NSAIDs leave collateral damage including stomach problems and elevated risk of heart attacks and strokes.
I occasionally took NSAIDs over the years mostly for headache or fever. After ankle surgery in 2007, my orthopedic doctor recommended that I take up to 1,600mg of ibuprofen a day. Two to three days later my stomach was burning up. I had experienced regular heartburn over the past 10 years and even had my stomach scoped at one time (nothing was found). It was no surprise that ibuprofen caused stomach upset. After my second ankle surgery, I tried Celebrex since it supposedly did not cause as many problems. Stomach upset eluded me but Celebrex did not seem to have much anti-inflammatory impact. After 30 days, the insurance company sent a terse letter indicating that they were not going to cover Celebrex unless my doctor had a good reason. They argued that over-the-counter NSAIDs are just as effective and cheaper.
This is where my use of NSAIDs ended until recently when my rheumatologist prescribed Mobic (meloxicam). Enbrel stopped working for me and joint pain and damage was increasing. The first signs of finger bending were noticed. He felt that while I was waiting for my new biological medicine, Cimzia, to take effect, I should take a NSAID. He knew about my intolerance of NSAIDs but thought Mobic was worth a try since people typically display less problems with it. After two doses (taken twice a day), I could tell that my stomach didn’t like it either. I stopped taking it. I think about pulling it out and giving it another try; especially on those days when joints are screaming at me. But the thought of those stomach juices churning inside keep from reaching for those little yellow pills. While conventional warfare against RA via NSAIDs works for some, many cannot tolerate the side effects.