Your journey with rheumatoid arthritis (RA) can be complicated. Feel better prepared and informed by asking your rheumatologist these questions about your outlook, pregnancy, medications, and more.
If you have rheumatoid arthritis (RA), you’ll see your rheumatologist at regularly scheduled appointments. This subspecialty internist is the most vital member of your care team, providing you with an analysis of your condition and its progress as well as insights on the latest treatments.
Tracking this autoimmune condition can be a challenging task. Symptoms such as swelling and painful joints come and go, and new problems develop. Treatments can also stop working.
It’s a lot to remember, and you might find you forget to ask important questions during your appointment.
Here are some things to keep in mind that your rheumatologist wishes you’d ask.
The time of diagnosis can cause anxiety for many, though some also feel a sense of relief that the condition has been identified and can be treated.
While you’re taking in this new information, it’ll be helpful to start keeping a care journal or log that you bring with you to all appointments and use to track your condition at home.
During your initial appointments, ask your rheumatologist these important questions:
1. What’s my outlook?
Though RA behaves differently in all people, it’s important to understand some of the commonalities.
The condition is chronic, meaning it will almost certainly last your lifetime. However, chronic doesn’t mean unrelenting. RA has cycles and can go into remission.
Ask your doctor about your outlook, and try to take note of the good news along with the more worrisome information.
2. Is it hereditary?
Elyse Rubenstein, MD, a rheumatologist at Providence Saint John’s Health Center in Santa Monica, California, points out that it’s important to consider RA’s impact on your family. If you have children, you may want to ask whether they may develop RA.
While the heritability of RA is complex, there does appear to be a greater likelihood of developing RA if someone in your family has it.
3. When can I exercise again?
Pain, sleeplessness, fatigue, and depression can interfere with your getting regular exercise. Once you’re diagnosed, you might even be afraid to exercise because of the impact on your affected joints.
Ask your doctor when you can get moving again and what exercises will benefit you most. Swimming or water aerobics are particularly good for those with RA. Learn more about RA-friendly forms of exercise.
4. How long will it take for my medications to work?
For decades prior to the 1990s, nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids were the primary prescriptive solutions for people with RA. They provide relatively fast relief for swelling and pain and are still in use.
(Opioid and opiate pain relievers are associated with a high rate of addiction, so the prescription of these medications for RA is on the decline.)
Two treatments — DMARDs and biologics — take a different approach. They affect the cellular pathways leading to inflammation. These are excellent treatments for many people with RA, because stopping inflammation can prevent permanent damage to joints.
DMARDs and biologics do take longer to work. Ask your doctor about their experience with these medications.
If you’ve been managing your RA for some time, you probably have an established routine for your doctors’ appointments.
You arrive, have your vitals taken and blood drawn, and then meet with your doctor to discuss your status and any new developments.
Here are some questions to consider bringing up:
5. Can I get pregnant?
Around 90% of people with RA will take methotrexate at some point, according to the advocacy group the Arthritis Foundation. This DMARD is the most commonly used RA medication overall. It’s generally considered safe for regular use and has manageable side effects.
However, this go-to RA drug is also an abortifacient, meaning it will cause a pregnancy to terminate. Always use birth control when taking methotrexate.
Also, always speak with your doctor if you’re considering getting pregnant. “Really, we should be telling patients about pregnancy without their asking,” says Stuart D. Kaplan, MD, a rheumatologist in New York state.
You can have a healthy pregnancy and healthy babies with RA. You may even enjoy a break from your RA symptoms. Just make sure to consult your rheumatologist regularly.
6. What if my medications stop working?
NSAIDs and corticosteroids help people with RA manage their pain and swelling, while DMARDs slow disease progression and can save joints. You were most likely prescribed these medications soon after you were diagnosed, but they might not always work.
The need for additional or different medications could be temporary. For example, during a flare-up, you could need additional and temporary pain relief. You may also need to change or add treatments over time.
Talk with your rheumatologist throughout your treatment to understand how to tell when a treatment is no longer working and how to plan for a change in treatment when needed.
7. What new treatments are available?
RA treatment research and development is rapidly advancing.
In addition to older DMARDs such as methotrexate, newer drugs called biologics are now available. These work similarly to DMARDs — by blocking cellular inflammation — but are more targeted in their interaction with your immune system.
Stem cells might hold promise as an RA treatment, too.
8. What’s triggering my flare-ups?
The remission-flare pattern of RA can feel particularly unjust.
One day you’re feeling fine. The next you can hardly get out of bed. You can take some of the sting out of this injustice if you establish why you get flare-ups — at least then you have an idea of what to avoid or can be alert to an oncoming flare-up.
Keeping a care diary might help you track your triggers, and so will consulting with your rheumatologist. Ask about their experience with other people. Together, refer to their record of your appointments to identify what might be activating disease symptoms.
9. What about drug interactions?
The array of RA medications can be overwhelming.
Even if you don’t develop RA comorbidities such as cardiovascular problems or depression, you’ll likely take a prescription anti-inflammatory, a corticosteroid, at least one DMARD, and possibly a biologic.
These medications are considered safe to take together, but if you’re wondering how they might interact with other substances, ask your doctor.
10. Do I really have to take my medications forever if I feel well?
Perhaps your RA has entered an extensive remission. You find you’re able to move as you once did, and your pain and fatigue have subsided.
Could it be your RA is cured? And could you stop taking your medications? The answer to both these questions is no.
RA still has no cure, even though modern therapies can bring relief and prevent further damage. You must continue to take your medications to be well.
“Once remission is achieved on medications, patients will maintain low disease activity or in some cases no identifiable disease activity at all by continuing the medications,” says Rubenstein.
“When medications are stopped, there is a high likelihood of disease activation and flares occurring again.”
However, your doctor may consider lowering the dose of your medication or simplifying your drug combination with careful monitoring.
Your rheumatologist is your companion on what you hope will be a healthy journey in treating your RA. That journey is long and can get very complicated as you add and subtract treatments and as your disease flares up, remits, or develops new traits.
Keep a care journal to write down your own experiences, list your medications, and track symptoms. Also, use this notebook as a place to list questions for your next rheumatology appointment. Then don’t hesitate to ask them.
Editor’s note: This story was first published on February 1, 2017, and the expert interviews were conducted that same year. Its current publication date reflects a new medical review.