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Treatment Options for Palindromic Rheumatism

This is my second post on Palindromic Rheumatism   (PR). PR is an autoimmune disease characterised by sudden, rapid and recurrent attacks ...

This is my second post on Palindromic Rheumatism (PR). PR is an autoimmune disease characterised by sudden, rapid and recurrent attacks of arthritis. Because the condition is rare, there has not been much research done in this area and the experts do not know for sure what triggers the inflammation. At the moment there are three main treatments for PR:
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Steroid injections
  • Disease-modifying anti-rheumatic drugs (DMARDs)
NSAIDs - These are a class of drugs with analgesic(pain-killing) effects. In higher doses they can also have anti-inflammatory effects. Most of us would have used NSAIDs (like Aspirin, Ibuprofen etc.) at some point or the other to treat headaches, back pains, fever etc. I was prescribed NSAIDs when my PR symptoms first showed up(before the diagnosis). I did manage the pain for some time with these but then decided to reduce my dependence on them because it aggravates my GERD symptoms.

Steroid injections - Once my condition was diagnosed and after many visits to the specialist, when my pain showed no signs of reducing, I was offered a steroidal injection. I opted for it as at that point of time the joints were inflamed and causing a lot of pain. Steroid injections take a few days to work. For 2 days after taking the injection there was no change in my pain levels. But from the third day, it was considerably reduced. I could say it was as good as gone. The amount of time the effect lasts depends on the dosage of the injection. I had pain free days for almost 3 weeks before it started coming back again. If you suffer from PR, you could discuss with your doctor about local steroid injections, the dosage, side effects etc. I was told that I might notice side-effects like increased appetite, changes in mood etc. But thankfully I did not experience any such side-effects. One main thing to note here is that these injections only relieve the symptoms of PR, they do not have any effect on the condition itself. That is, they do not prevent the spread of the inflammation process internally.

Disease-modifying anti-rheumatic drugs (DMARDs) - These are usually the last choice of treatment for PR, if everything else fails to have an effect. DMARDs are said to work by dampening the disease process instead of just treating the visible symptoms (i.e. pain and stiffness). DMARDs need to be taken for long term. They do not show an immediate effect. And when you are on DMARDs, you will need to be monitored regularly for possible side-effects including kidney and liver problems and some problems with the eyes as well. As in my case, the rheumatologist will take a decision after discussing with you all the possible side effects. I am still having a think about it and have not opted for DMARDs. If my condition does not improve over the next couple of months, then maybe in the new year I will opt for DMARDs.

Until then I am managing my conditions by using NSAIDs, topical pain relieving applications and heat therapy.

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