Living with rheumatoid arthritis (RA) is a journey filled with ups and downs, and one of the most challenging aspects can be finding the right treatment. For many patients, medications are a lifeline, offering relief from pain, inflammation, and the progression of joint damage. But what happens when those medications don’t work as expected? It’s easy to feel like you’ve failed the treatment, but the truth is, the medications may have failed you.
April 2025 marks 10 years since my rheumatoid arthritis diagnosis – and 10 years of many different medications without the relief that I need – I am seropositive and considered severe RA, along with comorbidities. It’s been a long, drawn out process of trying to find the right medication for me and at times I do feel like I have given up hope. I came close to remission once while on a biologic but it stopped working due to a number of factors. Following the latest research constantly provides me with a source of hope.
Another aspect that gives me hope living with RA is remembering my aunt who lived with rheumatoid arthritis for many years before my diagnosis. I was never blind to RA growing up. My aunt, Elaine, my dad’s sister, suffered greatly from it yet my family didn’t understand what she was going through. She was diagnosed at a time with minimal medications, when they treated RA with gold. I never saw her walk more than a few steps, she was always in pain and her hands were deformed. My aunt Elaine passed away from the comorbidities that followed after her rheumatoid arthritis diagnosis the same week I was diagnosed with RA.
Medications now have advanced beyond the opportunities my aunt had. Less patients with RA require wheelchairs or have the deformed hands. Medications can also help prevent a lot of the serious comorbidities that come with an RA diagnosis.
I have seen firsthand what this disease looks like when left untreated and the results are devastating and debilitating. Mysearch trying to find the right medication is a huge part of how I am fiercely fighting rheumatoid arthritis.
Why Medications Can Fail in Rheumatoid Arthritis
Rheumatoid arthritis is a complex autoimmune disease that affects each person differently. Medications, particularly disease-modifying antirheumatic drugs (DMARDs) and biologics, are designed to target inflammation and immune system dysfunction. However, treatment success is not guaranteed, and research shows that a significant proportion of patients experience treatment failure.
A study published in Arthritis Research & Therapy found that approximately 10% of RA patients are considered “multi-refractory,” meaning they fail to respond to multiple biologic DMARDs. Factors such as disease severity, genetic differences, and comorbidities can influence how a patient responds to treatment. Additionally, the “trial-and-error” approach often used in RA management highlights the limitations of current therapies.
It’s Not Your Fault
When medication doesn’t work, it’s natural to feel frustrated or even blame yourself. But it’s important to remember that treatment failure is not a reflection of your effort or commitment. Medications are designed to target specific pathways in the immune system, and if those pathways aren’t the primary drivers of your disease, the treatment may not be effective.
The European League Against Rheumatism (EULAR) defines “difficult-to-treat RA” as cases where patients fail multiple treatments and do not achieve disease control. This definition underscores the complexity of RA and the need for personalized approaches to care. You didn’t fail your medications—they simply weren’t the right fit for your unique disease profile – they failed you.
Why Treatment Failure Happens
There are several reasons why RA medications may fail, including:
- Primary Inefficacy: The medication doesn’t work from the start because it doesn’t target the specific mechanisms driving your disease.
- Secondary Loss of Efficacy: The medication works initially but loses effectiveness over time, often due to the development of resistance or changes in disease activity.
- Side Effects: Some patients discontinue medications due to intolerable side effects, such as infections, gastrointestinal issues, or fatigue.
- Comorbidities: Conditions like diabetes, cardiovascular disease, fibromyalgia or depression can complicate treatment and reduce its effectiveness.
The Importance of Precision Medicine
The future of RA treatment lies in precision medicine, which aims to tailor therapies to individual patients based on their genetic, molecular, and clinical profiles. Researchers are exploring biomarkers that can predict treatment response, allowing for more targeted and effective interventions. While this approach is still in its early stages, it offers hope for overcoming the limitations of the “trial-and-error” method.
As someone who has gone through countless medications, feeling like I am running out of options, precision medication means a lot to me because it means hope for a clear path to the treatment I need to treat my severe rheumatoid arthritis.
What You Can Do
If you’re struggling with treatment failure, here are some steps to take:
- Communicate with Your Rheumatologist: Share your concerns openly and ask about alternative treatments or combination therapies.
- Explore New Options: Advances in biologics, targeted synthetic DMARDs, and other therapies mean there are more options than ever before.
- Consider Lifestyle Factors: While medications are crucial, lifestyle changes like exercise, stress management, and a balanced diet can complement your treatment plan.
- Advocate for Yourself: You are your own best advocate. Don’t hesitate to seek second opinions or ask about clinical trials for emerging therapies.
Remember This: You Did Not Fail Your Medications
Treatment failure in rheumatoid arthritis is not uncommon, but it’s important to remember that it’s not your fault. Medications are tools, and finding the right one can take time. With ongoing research, advancements in precision medicine, and a proactive approach to care, there is hope for better outcomes and improved quality of life.
You didn’t fail your medications—they failed to meet your needs. And that’s a challenge we must face living with rheumatoid arthritis but there is hope.
