Rheumatoid arthritis (RA) can be difficult to diagnose and occasionally hard to treat. While nonsteroidal anti-inflammatory drugs (NSAIDs) and occasional corticosteroids often keep pain and swelling at bay, sometimes they can be inadequate during a flare.

Disease-modifying antirheumatic drugs (DMARDs) succeed in suppressing the immune reaction that causes inflammation in many people. But DMARDs can stop working, for reasons that aren’t always clear.

Biologics are offering hope to many with RA. Like DMARDs, they work with your immune system to block inflammation, though biologics are more targeted. However, biologics aren’t always successful either.

Everyone’s experience with RA treatments varies. Read how two people with RA dealt with their progressing symptoms, and see what they did to achieve symptom relief when treatment stopped working.

While NSAIDs work quickly to stop pain, DMARDs usually take several weeks. That wasn’t the case for Vera Nani, however.

Nani was diagnosed with RA in 1998. She didn’t know what to expect when her doctor started her on DMARDs. “It was in 2005 when I had my first treatment. My rheumatologist stated it would more likely take effect in a week or two. The following morning, I woke up and got out of bed just like I used to, before the RA developed. How wonderful it felt to feel normal again!”

But as is sometimes the case with RA treatments, Nani’s stopped working. Worse yet, even though the drug wasn’t helping her, she was experiencing side effects. “For years, every other treatment, my back started to hurt. Sometimes I couldn’t walk. Then I started developing urinary tract infections.” Years into these discomforts, Nani’s insurance changed and suddenly her prescribed DMARD was no longer covered. “I now believe it was for the best,” she says.

But for pain relief, she now only relies on ibuprofen and the occasional steroid injection. “I struggle with the pain,” she admits. Two young neighborhood children often drop by to ease her pain by rubbing essential oils on her sore joints. Remarkably, Nani continues to construct forts and playrooms for her many grandchildren when her pain is less intense.

Clint Paddison has RA that is now in remission. He was receiving treatment that included the DMARD methotrexate when his doctor told him that wasn’t enough. “I knew my maximum dose of methotrexate wasn’t working when I was told I’d need to go on to even more aggressive immunosuppressant drugs, or a combination therapy,” says Paddison.

That wasn’t a choice he was willing to make. Paddison instead attacked his RA through diet and exercise and says his blood tests now confirm his body is free of inflammatory markers.

Despite Paddison’s self-proclaimed success, this isn’t the right choice for everyone, and some doctors believe it isn’t safe. “No dietary modification alone can be expected to control rheumatoid arthritis,” says Alan Schenk, MD, a rheumatologist at Saddleback Memorial Medical Center, Laguna Hills, California. “However, eliminating saturated fats, avoiding obesity, and controlling cholesterol can reduce inflammation and mitigate the associated risks of cardiovascular disease.”

The bad news is that there’s still no cure for RA. The good news is that RA research and drug development is advancing rapidly. DMARDs and biologics are saving joints from damage and allowing people with RA to lead active lives. Those medicines don’t always continue to work, but the idea that the field is progressing provides hope.