I want a new drug...

This photo represents my day. A Wednesday, more accurately, since there, in the foreground are the Little Yellow Pills of Doom (Methotrexate) and those are only taken on Wednesdays. These are all the things I have to take in order to make it through a day. Not a "if I just take these pills I feel all better and I can run and jump and climb trees" kind of make it through, but a "if I just take these pills I will be able to get dressed by myself- as long as there are no buttons- and feed myself" kind of making it through the day. See over there on the left? That's the Prednisone. Yeah, I know, bad, evil, terrible steroids, but without them I wouldn't even be able to get out of bed. Heck, I wouldn't even be able to roll over in bed. And I realize now that this photo is missing my calcium pills which I have to take in order to counter-act the calcium leaching steroids.

Anyway, next to the Prednisone we have my NSAIDS, which may not actually be doing anything, but since they might be, my rheumatologist is hesitant to take them out of the mix. Next comes the folic acid. It's an insane amount of folic acid. Something like 100 times the RDA. See, the Methotrexate is a folate antagonist which means it blocks the function of folic acid in my body. This one is a tricky medication, though, because if I flood my system with folic acid it should, in theory, make the Methotrexate less effective. In reality, it doesn't really seem to reduce efficacy much at all and what it does do is lessen some of the more severe side effects of Methotrexate, such as mouth ulcers and nausea.

The last medication in the photo, the one all the way on the right, is a narcotic. It's the one I only take when absolutely necessary. I am not a big fan of narcotics. Most of them either make me sick or super sleepy, or if I'm really lucky, both. This is what I resort to when the choice is take the pills or lay in bed and cry.

That's what I take right now. What I really want to be taking, what I, and my doctor, think will do the most to help me is one of Biologic DMARD's. DMARD stands for Disease Modifying Anti-rheumatic Drug, and the Biologics, like Enbrel, Humira, Orencia, etc. currently seem to be the most effective. I won't go into the specifics of how these medications all work. I'll save that for another post. The important thing here is that I, and more importantly in this case my rheumatologist, believe that I won't truly have any relief from symptoms and joint damage until I am on one of these medications. The American College of Rheumatology believes that quick, aggressive treatment is the most successful way to deal with RAD. Studies have indicated that beginning treatment with a DMARD, like Methotrexate, in combination with one of the Biologic DMARD's within the first three months of diagnosis is the most effective way of reducing permanent joint damage and achieving remission.

So, why am I not using this medication now? Two words. Insurance companies. Yep. This medication and course of treatment that my doctor feels I will benefit from, that studies show will actually help me maybe get my life back needs to be approved by my insurance company before I can try it. And unfortunately, my insurance company requires that I be on oral DMARD's (such as methotrexate) for 3-6 months without success before they will cover the very sizable cost of Biologics. Yes, you read that right. Doctors agree that it is important to begin treatment within those first three months while my insurance company prefers to make me wait up to 6 months before approval.

Maybe it's just me, but it seems very wrong that a medical treatment that my doctor believes will benefit me right now has to wait because the insurance company says so. If it weren't for the fact that Biologics are some of the most expensive medicine in the world, costing anywhere from $15-30,000 a year, I would not even bother with insurance.

So, I wait. With any luck, my next doctor visit at the end of April will result in (finally!) a prescription for medication that will help me.