Dealing with rheumatoid arthritis (RA) can be like solving a puzzle – each person's journey is unique. Figuring out the best treatment approach requires careful consideration, as what once worked might not stay effective forever. Changing your RA treatment plan is a normal part of managing the condition and keeping it under control.

Let's dive into the signs that signal a need for a change in your RA treatment:

1. Unfamiliar symptoms

If RA typically targets certain joints, but now you're experiencing discomfort in new areas like your knees, it's time to chat with your healthcare provider. This shift could indicate that your condition is evolving, and exploring a different arthritis treatment option might be needed. People on disease-modifying anti-rheumatic drugs (DMARDs) might switch to biologics, which are often prescribed for more severe cases. Janus kinase (JAK) inhibitors might be explored in cases where biologics haven't brought relief.

2. A flare-up

RA symptoms like stiffness and fatigue can sometimes intensify for periods, known as flare-ups. These can be triggered by stress, other health issues, or sometimes just out of the blue. During a flare, your doctor might adjust your treatment by adding corticosteroids to your regimen or modifying your current medication dosage.

3. Infection concerns

Individuals using biologics or JAK inhibitors face a slightly higher risk of infections due to their impact on the immune system. According to the Arthritis Foundation, lung-related complications beyond joint issues are common with RA; certain medications could increase this risk. When faced with severe infections like the flu, doctors often recommend temporarily pausing disease-modifying medications, as fighting infections becomes tougher when RA drugs are present.

4. Treatment losing effectiveness

If your symptoms worsen after a period of improvement, it could signal that your medication is no longer as effective as before. Some patients develop antibodies in their bloodstream that counteract the medication's benefits. However, this change might be subtle – symptoms might not return with the same intensity as before treatment.

When a medication becomes less effective, a switch is often required. Combining them with a biological drug might be suggested for those on DMARDs. Biologics target inflammation-triggering processes in the body. If you're already on a biologic, transitioning to a different variant could prove beneficial. Exploring newer drugs like JAK inhibitors might be recommended when biologics aren't delivering results. Collaborating closely with your healthcare team is vital to determine the right shift for you.

5. Achieving remission

You might be in remission if your RA symptoms have been minimal for six months or more while on medication. A study published in August 2019 in PLoS One suggested that over half of those in remission remained so two years later. Reducing DMARDs might be considered for those in remission, though some level of treatment is usually maintained.

Experts differ in their approaches to remission management, but some suggest altering your medication routine. Transitioning from a biologic to a DMARD, which typically carries fewer risks and side effects, might be proposed if you're on a biologic medication.

6. Developing an infection

Biologics and JAK inhibitors can weaken the body's immunological defenses, increasing the risk of infection in those who take them. The most frequent RA symptoms, outside of joint pain, are lung issues. Taking particular drugs can make this risk even higher. Doctors typically advise discontinuing disease-modifying medications when major diseases like the flu or a bacterial infection emerge. 

You don't want to let an illness spread unchecked. Recovering from an illness is substantially more difficult when RA medications are present. After the infection has subsided, just make sure to consult your doctor if you think you might have an infection; don't change your medication schedule on your own.

The bottom line 

Regarding rheumatoid arthritis, adapting your treatment strategy is a necessary and positive step. By staying attuned to these signals and maintaining a solid partnership with your healthcare team, you can navigate the ever-changing landscape of RA management.