My mother was diagnosed with Rheumatoid arthritis 19 years back, all her test results are normal, just that lefumide or lefra has stopped helping in easing the pain, but steroids like Defza 6 or Dezacore help. Her doctor has asked her to start using biologics. I have done my research, and the side effects I've come to know of are alarming, more so, biologics are too expensive. Isn't there any other alternative? She is 46 years old.

Dr. Julie Mercy J David RajaPhysiotherapist21yrs exp

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It is called as Rheumatic arthritis. If your pain is more in the distal joints, ie. In the upper limbs if the pain is present in the fingers/wrist and in the lower limbs it the pain is present in the toes/ ankle, then we shall definitely say it is Rheumatic arthritis. Wear elbow brace and wrist brace which will make her to feel warm and that will make the joints become firm. Hot water fermentation will help Knee cap will also help to prevent the damaged cartilages. If your pain is more in the distal joints, ie. In the upper limbs if the pain is present in the fingers/wrist and in the lower limbs it the pain is present in the toes/ ankle, then we shall definitely say it is Rheumatic arthritis. Which joints you have pain? If your proximal joints (ie. Shoulder, hip & knee has pain) then you can pour hot (warm) water in that area to reduce the inflammation. If you have pain in the distal joints ie. Wrist, fingers, ankle, toes then you can wear either elbow brace or wrist brace which will help you to feel warm and very protective. And also immerse the distal joints in the hot water tub which will help you to reduce the pain. Consult the near by physiotherapy clinic and also consult a general physician to check with your ESR levels to check whether you have inflammation The sound what you hear is called as Crepitus /?kr?p?t?s/ (also termed crepitation) is a medical term to describe the grating, crackling or popping sounds and sensations experienced under the skin and joints or a crackling sensation due to the presence of air in the subcutaneous tissue. Popping Knees and Crackling Knuckles. Occasionally hearing pops, snaps, and crackles when you bend your knees doesn?t necessarily mean you have arthritis. The kneecap (patella) is the small, convex bone that sits at the front of the knee, shielding the joint.  

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Dr. Nilesh NolkhaRheumatologist7yrs exp

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Biologics are very good drugs, if used judiciously and has changed the way RA can be treated. You can technically use leflunomide, methotrexate etc, but many times they are intolerable. RA is a disease which makes you miserable, which is sometimes more worse than cancer which either kills or gets cured (I have put it simply and morbidly but unfortunately people will spend anything for cancer even if they are dying, but will see side effects of biologics and not use them, hence the comparison). Yes, biologics are expensive. But they have been used safely in may patients for more than 30 years now. There is no guarantee that your mother will respond to that, but at least that is an option to consider. Don't fear side effects, you should not be using steroids like defza also then. Defza will make her feel a bit better though even if she has a lot of damaged joints, if things are not controlled joints will further get damaged, and it will only worsen things. Also, the more uncontrolled RA is, it can affect internal organs and be life-threatening, You have to think all of this before thinking that biologics have side effects. The side effects of biologics are far lesser than RA disease itself. They are standard of care in most developed countries for a reason. A good rheumatologist should be able to address your concerns including cost considerations, buts sometimes there are so far and few in between, so they always find it difficult to counsel well in a busy clinic. But I hope I have been helpful. Best wishes Regards.  

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