VOICE-OVER: So a patient may say, “This is the way I used to feel before I started taking this medicine. I feel that way again. I don’t look as bad, but that’s how I feel.” They’ll say things like, “I can’t walk as much anymore, I used to walk for 30 minutes a day, now after 15 minutes I’m wiped out.” That causes me concern.
This idea of undertreating RA is a huge issue. Because when you’ve been feeling lousy and then you start to feel a bit better, you accept a bit better as the best you could be. I use a composite of tests to tell me the number of tender and swollen joints. I look at their fatigue, their pain, and then I look at the goals we have set together. Are they moving towards those goals? That way I can tell if that patient has hit a treatment plateau that isn’t adequate. We can then talk about either switching the therapy, or advancing the therapy.
Another more common thing is that you get to a spot that feels really great, you’re doing well and then something happens. Is this just a hump in the road, a flare, or do we need to think about this differently?
Patients may self-increase pain medication because they were having a flare and they didn’t want to bother me. So I’ll ask, “Are you taking extra of something to manage this? Are you limiting your activities because, let’s say, your knees are hurting you?”
And it’s important for patients to understand that their goal really is to get this disease under control, because there are long-term ramifications that go beyond their joints and feeling tired that can actually affect their general health.