What to do when RA treatment doesn’t work or stops working

When treating a condition like rheumatoid arthritis (RA), having treatment options is helpful—as anyone who has been treating RA for any length of time will know, not every medication will work for every person.

Here, we look at the reasons why a medication may not work and the signs that it may be time to switch treatments.

The medications that treat RA

RA is a type of inflammatory arthritis. When a person has inflammatory arthritis, abnormal immune system activity causes inflammation and damage to the tissues that make up the joints. RA is sometimes described as an autoimmune disease or an immune-mediated disease.

Over time, RA can cause permanent damage and deformity in the joints. This can lead to chronic pain, mobility problems, and in some cases, disability. Treatment can help prevent these outcomes.

Treatment for RA often involves taking medications called DMARDs (disease-modifying antirheumatic drugs). DMARDs target RA inflammation at the source—the immune system.

There are a variety of DMARDs available, some that work by suppressing immune system activity, others that work by targeting specific inflammatory processes in the immune system.

Why medications do not work

There is still much we do not know about RA, including why some people develop RA and others do not, and why certain people respond better to certain medications.

There is some research that has looked at the ways that genetics and biomarkers might influence a person’s response to different medications. (A biomarker is a specific molecule in the body that can be a sign of a condition or disease.) Expanding on this research may help healthcare providers predict which medications may work better for certain people.

Sometimes a medication will work for a while and then begin to work less well or stop working. This can occur when the immune system begins producing anti-drug antibodies (ADAs). When this occurs, the immune system targets the drug the same way it would a harmful invader and blocks the drug from working.

In other cases, the effectiveness of a drug can be influenced by other factors. Difficulties taking every dose of the medication on schedule or filling a prescription will affect how well a medication works. People with RA who are overweight or obese are less likely to respond to treatment and more likely to have worse outcomes. Depression is prevalent among people with RA, and is associated with more severe RA.

In other words, there are many different factors that can contribute to how well an RA medication works—and these factors will be different for each person.

Signs an RA treatment isn’t working

It’s important to recognize the signs that an RA treatment isn’t working or has started to work less well. Some signs to look for:

• Symptoms are staying the same or getting worse.
• You are noticing new symptoms.
• Old symptoms have reappeared after remission.
• Flares of symptoms have become more frequent, more severe, or are lasting a longer time.
• RA is still interfering with your life, making day-to-day activities and responsibilities difficult to keep up with.
• Tests and exams show high levels of disease activity or detect ADAs.

Sometimes changes in symptoms can be difficult to notice—and if you are not keeping a symptom journal already, now is a good time to start. A day-to-day look at your symptoms can provide useful information for you and your rheumatologist.

What to do when treatment isn’t working

The good news is that there are a lot of treatment options available for RA, and many people switch medications several times before finding one that works.

If you think your treatment isn’t working, make an appointment with your rheumatologist, who will be your best source of information about your treatment options and the next steps that you should explore.