I injected a painful wrist joint in April 2009 and preached the value of biologics, but she chose again to return to the out-of-state physician for IV antibiotics. She came back and told me that she felt the treatment had helped her, but she described the trip as the "drive from hell" and that offset much of her benefit. The trip was hard on her because her husband was becoming demented, and she had to do the entire long drive with painful hands while at the same time keeping an eye on her husband.
In August 2009, I ordered hand x-rays. She delayed for 7 months before she finally got these done. The x-rays showed erosions. Well, duh?! She never started the etanercept because she was afraid of it. After her Multi-Dimensional Health Assessment Questionnaire (MDHAQ) Rapid 3 score rose to an amazingly bad 26.3, she reluctantly agreed to try certolizumab. She did well on this medication for about 6 months, and then she had a big flare-up of her arthritis. I switched her to abatacept and so far she has done well, even tapering off prednisone after many years of treatment. She was left with painful foot and toe deformities. A very good podiatrist told her to postpone reconstructive surgery as long as she could because the foot doctor predicted a long and painful postoperative course.
I suspected her outcome would have been better if she hadn’t procrastinated starting effective therapy for so many years, but there isn’t any room in my practice for saying "I told you so."
Dr. Greenbaum is a rheumatologist in practice in Greenwood, Ind. This column, "Inside Rheum," appears regularly in Rheumatology News, a publication of Elsevier.