There exists a definite gap in the RA literature about constitutes a “flare.” Although everyone talks about them, you won’t find a clinical definition or set of criteria. During a visit to my rheumatologist today, in addition to routine questions about medications, the nurse asked if I was experiencing any flares. I had to be honest that the past few weeks have not been pleasant as an increase in joint pain, joint swelling, and fatigue reared its ugly head. My rheumy has a great way of discussing symptoms, examining joints, and asking questions to paint the big picture. Always in the back of my mind is whether or not the current treatment regime is working. After the conversation and exam, it became clear that a hefty load at work (60-70 hours a week, 6 days a week), combined with recovery from sinus surgery in September, were contributing to how RA was behaving. My rheumy called it, “on the edge of smoldering”. She wants to tweak with my meds by upping the dose of Arava to 15mg daily in an effort to knock the symptoms down a little while avoiding the nausea I experienced at 20mg. Getting some rest is also prescribed now that a very busy deadline season at work is done.
As part of the recent smoldering, trochanteric busitis in the left hip has gotten worse. Since the nurse made a note of this, my rheumy walked into the room holding a syringe…I knew what was coming. An injection of depo-medrol, a corticosteroid, combined with lidocaine was prepared as I lay half naked on the exam table. I jokingly asked if the depo-medrol came from the same manufacturer that caused the recent spate of meningitis deaths. She laughed and said everyone had been asking the same question lately and that it was from a different source. There was hardly any sensation when she said it was all done. Now I wait to see if the injection will put out the smoldering fire in my hip. She said that if it doesn’t get better within two weeks, to call and come back in for a second injection. In the meantime, I’m taking the rest of the day off and doing nothing but having lunch with my wife and watching the World Series.
I’ve been reading up on the immune system and the role of B cells since I recently read about a new possible line of RA research and treatments related to B cells. My next post will focus on this topic.
Creative Commons photo credit: http://commons.wikimedia.org/wiki/File:Depo-Medrol_(Methylprednisolone_Acetate_injectable_suspension,_USP).jpg