Want the inside track on managing your rheumatoid arthritis (RA)? Here are the findings of five research studies presented at the 2018 American College of Rheumatology meeting that can make an immediate difference in your care and in how you feel…

Speak up if symptoms don’t improve. This tip may sound obvious, but a study done at the University of Alabama at Birmingham involving 50,000 patients found that 50% of them had no symptom improvement after a year…and yet stayed with the same treatment throughout that time. The researchers say that patients and doctors need to raise their expectations because RA treatment has improved to the point where most people should experience excellent relief and near-normal levels of function. Bottom line: If your current treatment hasn’t worked in a reasonable amount of time—typically three months—speak up. It’s likely time to try another drug.

If you take hydroxychloroquine (Plaquenil), check your dose. This drug, a “disease-modifying antirheumatic drug” or DMARD, is effective, but one of its serious potential side effects is retinal toxicity, irreversible damage to nerve cells in the back of the eye. To help prevent this, the dosing guideline from the American Academy of Ophthalmology was lowered from 6.5 mg per kg (2.2 lb) of body weight to 5 mg per kg in 2016. But this guideline is not always followed by rheumatologists.

A Duke University initiative aimed at increasing compliance with the guideline among doctors found that it’s not being followed about 37% of the time. Patients most at risk of taking too high a dose were those weighing 80 kg (about 176 pounds) or less. In some cases, providers interviewed for the initiative expressed concern that patients would experience more arthritis flare-ups with lower doses. Bottom line: Work with your doctor to find the right balance between managing RA and reducing your risk for retinal damage. Also, be sure to get all eye tests recommended for people on hydroxychloroquine to catch any damage early on.

Optimize your biologic DMARD. Biologic drugs are very effective, but they’re also very expensive and can have significant side effects. Once you’re symptom-free (in remission), scaling down to a lower dose can be cost effective and reduce the risk for side effects. “Optimization” is the process of finding the lowest dose that is still effective, typically by either reducing the size of the dose you’ve been taking or increasing the interval between doses. One concern has been that such a reduction could raise the risk for a relapse, but researchers in Spain demonstrated that this is not the case. They followed 70 patients who had been in remission for six months and whose biologics were optimized. After four years, most of the patients continued to maintain low levels of disease activity. Bottom line: If you’re taking a biologic and are in a sustained remission, ask your doctor whether this optimization approach makes sense for you.

Get the high-dose flu shot no matter your age. Having RA increases your risk of experiencing a more severe, even life-threatening, flu. Researchers from McGill University in Montreal found that the higher strength flu shot, which is usually given to people over age 65, could benefit anyone with RA regardless of age. Patients getting this version of the flu vaccine were close to three times more likely to develop immunity to flu viruses prevalent during the years of the study and with no signs of increased RA symptoms. Bottom line: Request this version of the vaccine the next time you get your shot.

Start bone scans before age 65. Researchers at Lancaster University in the UK who reviewed bone-density scans in close to 7,000 patients over 11 years found further evidence that bone loss occurs more quickly, particularly in the femur, among those with RA than in the general population. When bone loss progresses undetected and osteoporosis develops, the risk for fracture increases. Yet despite the known link between RA and osteoporosis, there are no clear-cut guidelines for bone-density testing in RA patients. (The standard guideline from the US Preventive Services Task Force is to start bone testing at age 65 for women, but that doesn’t take into account whether or not you have RA…and there is no similar guideline at all for men even though men, too, get RA and can experience bone loss.) Bottom line: Don’t depend on any generalized guidelines for when to start bone-density testing. Instead, ask your rheumatologist whether you should have bone-density testing regardless of your age. The British researchers also recommend that bone scans be done more frequently than recommended for the general population so that any bone loss can be detected as early as possible.

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