I’m a bottom-line, cause-and-effect kind of girl. You know, every action/equal and opposite reaction kind of stuff. Unfortunately, RA doesn’t always subscribe to the same theories that I do.
Pain is one of those things you learn about early in life. You get pinched as a baby — you hurt. As a child, you fall down and skin your knee — you hurt. But the hurt goes away. The pain heals along with the knee until both the skinned spot and the hurt are distant memories. Ergo, remove the cause (skinned knee) and the effect (pain) is also removed.
I saw my rheumatologist in December (and again today). It was my first visit since starting Cimzia and I wasn’t doing well. The Cimzia hadn’t yet started being very effective and I had finished the course of Mobic that I’d been on since knee surgery. So not only was I not getting full treatment for RA, I had lost the anti-pain and anti-inflammatory benefits of the Mobic.
I tend to equate pain with RA activity, kind of like that skinned knee of my childhood. Skinned knee = pain. Healed knee = no pain. Therefore if RA activity = pain, then no RA activity should = no pain.
I guess if I’d thought about it, I’d realize that’s not necessarily the case and so, during the conversation with my rheumatologist, I was caught a bit by surprise when she suggested something additional for the pain.
Unfortunately there is a lot of residual pain that comes along with RA. If a joint becomes damaged before RA is brought under control, that damage is going to continue to cause pain even if RA goes into remission. On a shorter-term scale, having RA means your joints or tissues are going to become swollen and/or inflamed. They don’t instantly revert to normal the moment that the RA calms down. It takes them a while to recover.
From that realization came the discussion with my rheumatologist that treating pain, although connected to treating RA, is a separate course of action. It’s something that I don’t necessarily think all doctors “get”. RA is a complex disease and there needs to be a multi-faceted approach to treating it. Not only do you need to attack the disease itself, there is the pain factor, and often other factors such as mental health and overall physical well-being that need to be addressed above and beyond the RA treatment plan.
In my case, we restarted the Mobic. While more an anti-inflammatory than a specific pain treatment, it can and does serve as both. My rheumatologist and I both agreed that I’m not a candidate for classic pain treatments — such as hydrocodone three times a day. My career is too challenging and lifestyle too active to be bogged down by these types of drugs.
My appointment today was much better than the last one. The Cimzia is taking effect although I can tell that it doesn’t quite “stretch” the full two weeks between injections. And the Mobic is helping. I had to go off of it recently for a few days and I could tell a real difference. So we’re continuing the Mobic and keeping the Arava/leflunomide at 20 mg per day as well as sticking (no pun intended) with the Cimzia.
So other than a miserable cold that my husband and I have been sharing, the New Year is off to a pretty good start.
Wishing you a pain-free 2014.