Sandra was diagnosed in April 2010 and her current rheumatoid arthritis treatment includes Cimzia (certolizumab pegol), Methrotrexate, Sulfasalazine and Hydrochloroquine. Sandra’s consultant talked to her about reducing and eventually phasing out the last two drugs. She also takes painkillers; Diclofenac and Co-Codamol and Amitriptyline at night time.
Eighteen months ago Sandra started to complain of knee pain and then she also noticed that her thumbs were getting very stiff and swollen. Her GP did a blood test and when the result came back send her to the hospital for further examinations. In addition to more blood tests, in the hospital they examined her joints and felt and checked the swellings and where she was getting the pain. All these procedures helped to confirm the diagnosis of rheumatoid arthritis (RA).
Initially, Sandra was given Methotrexate but unfortunately, it failed to control her RA. Sandra was experiencing regular flare ups and constant fatigue. So Hydroxychloroquine was added. This too failed to have any effect and symptoms became worse. Sandra was then started on Sulfasalazine and had to be signed of sick from work. A few weeks later she was admitted to hospital. When she was admitted into hospital shereceived a number of therapies to try and improved her symptoms drainage of fluid and steroid injection to her knee and steroid injections to both hands, daily physiotherapy, occupational therapy and hydrotherapy. In hospital they added Hydroxychloroquine to her treatment and a few months later Sulfasalazine was also prescribed. She stayed on this combination treatment for quite a while but it was obvious from the blood results that the inflammation was not going down. In between, she was having regular steroid injections to help her cope with her pain and inflammation.
Sandra experienced a very bad flare up only a month after her last hospital stay. Her consultant then recommended for her to start on one of the anti-TNF treatments; and suggested Cimzia. Her consultant did the DAS score (counting all the joints for swelling and for pain); took note of her lethargic state and the high level of inflammation shown in her last blood test. Sandra was found to qualify for anti-TNF therapy but she had to be reassessed by the specialist nurse six weeks later. Sandra had to wait for her second assessment without the help of a steroid injection because it would have distorted the second DAS score.
The improvements Sandra has experienced since starting Cimzia have been gradual. For instance, her morning stiffness period is shorter and her knee has improved allowing her to walk without a limp and for longer. Her main problem is the lack of strength in her hands and wrists, she doesn’t dwell on the possible side effects of Cimzia because she said that her life after diagnosis was gloomy and therefore, she had no choice. Before Cimzia, she was scoring her level of pain as high as 8 to 9 but now she said it has reduced to 3 or 4. Cimzia was added to her combination treatment and Sandra’s consultant talked to her about reducing and eventually phasing out Methrotrexate and Hydrochloroquine.
On reflection Sandra recognises that RA has had a great impact on many aspects of her life. For instance, before her diagnosis she exercised everyday and hiked frequently alongside working full-time and managing a house on her own. Financially, Sandra now lives with a third of her original income and that she has had unexpected expenses such as buying an automatic car and many RA-friendly items for the kitchen.