Is the improvement in rheumatoid arthritis permanent or temporary?
Q: I have juvenile rheumatoid arthritis since the age of 15. Presently, I am 21 years old (female) and have been on DMARDs with the combination of vioxx (25 mg) for 17 months. Before starting these medicines my ESR was 122 and now it is improved to 20 otherwise I am still anaemic due to thalassaemia trait and my other tests such RA and ANA are negative. Nowadays I am taking lefora 20mg daily and it suits me. According to my doctor I have improved by 75%. I want to know whether this improvement is permanent or temporary? What is the guarantee that my joints will not deteriorate?
A:Treating rheumatoid arthritis is a highly objective science now-a-days. Not only ESR is to be looked at but the number of tender joints, number of swollen joints, your own assessment of your general health - all are combined and put through a computer based mathematical formula to get a figure called DAS28. If DAS28 is below 2.6 - it has been confirmed that joint damage does not progress. In fact in many patients actual healing starts to occur. For carrying out these measurements you would have to be under care of a rheumatologist who does DAS28 calculations on a regular basis. In your case, I am worried about your need to take a painkiller. If the disease is under full control the patient does not need any painkiller. It is likely that your disease may not be in full control. If so, then the joint damage would progress. I do not think that I can give all the detailed answers to your queries but, I feel that you must discuss these details with your rheumatologist. Leflunomide alone is usually not very successful in achieving full remission. I always combine it with methotrexate as well as hydorxychloroquine and try to achieve a DAS28 count of < 2.6 . You should also aim for the same.