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Do I need to take medicines for rheumatoid arthritis?

Q: I am a 86 years old male who has had two attacks of rheumatoid arthritis (RA) in the last two years. Do I need to take medicines for rheumatoid arthritis?

A:To the best of my knowledge there is nothing like 'attacks of rheumatoid arthritis (RA)' because RA is a chronic persistent and fluctuating inflammatory disease affecting several small joints including fingers, wrists, elbows, ankles, knees and feet. When properly treated with a group of drugs called 'disease modifying anti-rheumatic drugs' (occasionally combined with a new class of extremely effective drugs called biologics), the disease slowly goes in remission and becomes inactive. However, medicines do continue usually life-time (just as in patients with diabetes, high blood pressure etc.) although in tapering doses. In such an individual, there could occur a condition called 'flare' of RA but that is usually localised in a single or only a few joints. RA-flare usually requires either a local intra-articular injection of a depot-glucocorticoid preparation or jacking up of the dose of the main drug for RA called LD-MTX.

The sketchy history you have provided is difficult to interpret but, I would be surprised if it is really RA that you are having. My strong advice would be that you immediately contact an experienced and well-trained rheumatologist (not orthopaedic surgeon as they are not trained in the evaluation, diagnosis and treatment of systemic inflammatory rheumatic diseases) to first get your disease properly diagnosed and then advise you appropriate treatment. At your age, it is much more common to have crystal arthritis that can cause episodic intermittent arthritis - usually of a single joint. But I leave it for your rheumatologist to properly diagnose your condition and then treat it accordingly.

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