Thank you for this helpful summary. I would just like to add - twenty years ago, when I started working in clinical development of a drug for RA (Actemra), Enbrel and Humira had come to market only a few years earlier. When Actemra was approved by FDA, it along with the other biologics were very expensive and still are. At the time that meant that many patients had to suffer through many unsuccessful treatment trials with methotrexate or other DMARDs before they could try a biologic. Over time, though I am now retired, I have observed a trend in rheumatology towards offering more aggressive treatment (biologics) earlier, "Treating to target" a combination of clinical signs and symptoms as well as inflammatory biomarkers (Hs-CRP and ESR) - a composite score. The idea is to induce "remission" as defined by the composite score or even "low disease activity" in order to halt the biological processes that lead to joint degradation and disability, preserving the patient's quality of life. Patients and caregivers should be aware that if they are not experiencing a good response to a new treatment, there are multiple opportunities to move on to options that may be more effective.
I very much appreciate this reply and the work you did for these patients! My mom was one of these patients who had to argue with her insurance that methotrexate wasn’t a good option for her to get Enbrel covered!
I spent the 1990s trying to convince doctors that something was wrong. I had pain, fatigue, random fevers, dry eyes, and other symptoms. The doctors kept telling me I was fine. And the people at my workplace never believed that I was sick. I finally was able to go to a rheumatologist without a referral. It was a relief to find out I had RA, fibromyalgia, and Sjogren’s disease and could be treated. It required a lot of persistence but I finally was heard.
Don’t let doctors brush you aside if you think there’s an issue.
This breakdown of RA as an evolving immune mistake really clarifies what's happening beneath the surface. The distinction between OA's wear-and-tear versus RA's active immune attack is something I hadn't fully appreciated untilnow. I've seen family members go through similar cycles of trial-and-error with treatments, and the part about "treating to target" makes a lot of practical sense for halting progression early.
These claims aren’t supported by much robust data. I believe he also tends to frame things as anti-medication and implies RA has diet based causes… also given the financial incentives here I think skepticism is warranted.
Thank you for this helpful summary. I would just like to add - twenty years ago, when I started working in clinical development of a drug for RA (Actemra), Enbrel and Humira had come to market only a few years earlier. When Actemra was approved by FDA, it along with the other biologics were very expensive and still are. At the time that meant that many patients had to suffer through many unsuccessful treatment trials with methotrexate or other DMARDs before they could try a biologic. Over time, though I am now retired, I have observed a trend in rheumatology towards offering more aggressive treatment (biologics) earlier, "Treating to target" a combination of clinical signs and symptoms as well as inflammatory biomarkers (Hs-CRP and ESR) - a composite score. The idea is to induce "remission" as defined by the composite score or even "low disease activity" in order to halt the biological processes that lead to joint degradation and disability, preserving the patient's quality of life. Patients and caregivers should be aware that if they are not experiencing a good response to a new treatment, there are multiple opportunities to move on to options that may be more effective.
I very much appreciate this reply and the work you did for these patients! My mom was one of these patients who had to argue with her insurance that methotrexate wasn’t a good option for her to get Enbrel covered!
I spent the 1990s trying to convince doctors that something was wrong. I had pain, fatigue, random fevers, dry eyes, and other symptoms. The doctors kept telling me I was fine. And the people at my workplace never believed that I was sick. I finally was able to go to a rheumatologist without a referral. It was a relief to find out I had RA, fibromyalgia, and Sjogren’s disease and could be treated. It required a lot of persistence but I finally was heard.
Don’t let doctors brush you aside if you think there’s an issue.
This breakdown of RA as an evolving immune mistake really clarifies what's happening beneath the surface. The distinction between OA's wear-and-tear versus RA's active immune attack is something I hadn't fully appreciated untilnow. I've seen family members go through similar cycles of trial-and-error with treatments, and the part about "treating to target" makes a lot of practical sense for halting progression early.
Link to food?
https://www.drmcdougall.com/?s=Rheumatoid+arthritis+
These claims aren’t supported by much robust data. I believe he also tends to frame things as anti-medication and implies RA has diet based causes… also given the financial incentives here I think skepticism is warranted.
Thank you for this! Would love a similar discussion on Juvenile Idiopathic Arthritis.