old_black (old_black) wrote,
old_black
old_black

Optimising


Back in mid-2020 it was discovered that I had rheumatoid arthritis. I started taking prednisolone with immediate rapid relief of my symptoms. I then started methotrexate, which helped but didn't put me into remission. Hydroxchloroquine was then added, which again seemed to have some beneficial effect. At that stage I was only taking a low dose of prednisolone, but as the symptom graph below shows, when the prednisolone was stopped altogether my joints became worse than ever. So my rheumatologist decided to add golimumab - an injected monoclonal antibody based drug which costs about $1200 per dose but which the government subsidises to reduce the cost to $40 if you meet certain criteria (that you have lots of joints affected and you've tried other drugs without success).


As you can see, since I've been on golimumab there has been an improvement - but only a rather modest one. I am not sure that this level of improvement justifies the cost. I certainly wouldn't pay $1200 per injection from my own pocket.

Prednisolone was stopped because, although it's very effective, if taken long term it produces serious side effects, including osteoporosis. Methotrexate is said to not have many side effects but it can damage the liver and increase the risk of skin cancer. My rheumatologist decreased the methotrexate dose when liver damage was showing in my monthly blood tests. At the beginning of 2021 I developed gynaecomastia - which has been reported as being caused by methotrexate. To help minimise this side effect of methotrexate my rheumatologist suggested I take 5 mg folic acid every day. This seemed to reduce the gynaecomastia, but I developed anorexia, which has been suggested as a side effect of folic acid. Also, there's a suggestion of increased risk of cancer with higher doses (e.g 5 mg/day) of folic acid. So I reduced the folic acid to 1 mg/day - and the gynaecomastia got worse again.

I see the rheumatologist again in a few weeks. It's becoming increasingly likely that no drug regimen is going to deliver the degree of remission that is the aim of treatment. It's a complex process to optimise the treatment to give adequate relief of symptoms and minimising the adverse effect of RA on lifespan and functional ability, without causing unacceptable side effects.

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