Right treatment to RA can ensure quality of life

MANILA, Philippines - Most people believe that rheumatoid arthritis (RA) only happens in the elderly. They believe that it is a condition that only afflicts those who are in their 50s and above. Unfortunately that is not always the case. Arthritis can hit even very young patients and those who are in the prime of their adult life.

Such was the case for Kares Velasquez Hammond. She was 32 years old when she first began experiencing total body pain that began in her back and was followed by pain in her hands, wrists, and other extremities.

She attributed the pain to stress from her highly stressful job and tried to push through the pain. Unfortunately, as she and her then fiancé were shooting their wedding save-the-date video, her entire hand cramped up with pain, which she could no longer ignore.

“I thought I was just stressed,” she recalled. “It happens a lot in my line of work and I often lack rest. But it became pretty apparent that the pain was not going away so I thought it was best to see a doctor and find out what was causing it.”

A surprising diagnosis

Hammond first went to a neurologist because she was worried that it might be caused by problems with her nerves. She shared that she had on and off back pains for most of her life.

While living in Canada for nine years she also saw doctors for her recurring back pain. They recommended breast reduction surgery to help alleviate her back from some of the stress. She decided to undergo the surgery and it did offer some relief, but it was not total relief and pain did come back on and off.

“I think I have a very high threshold for pain,” Hammond said. “Looking back I think I might have been experiencing pain for much longer than I care to admit, but I just lived with it because it was not hindering my day-to-day life and I thought it would eventually just go away on its own.”

The neurologist gave Hammond a series of tests and checkups and she was cleared from any ailment. There was no explanation as to what was causing the recurrent pain and she was still seeking answers.

It was not long before the pain became uncomfortable that she began to have trouble sleeping. That was when things got truly alarming for her. Through the recommendation of her mom, she saw their family’s general practitioner who recommended her to Dr. Andrei Rodriguez, a rheumatologist at the Makati Medical Center.

“When I saw Hammond for the first time I already knew it was rheumatoid arthritis,” Rodriguez recalled. “The way her hands looked and the way she described the pain and symptoms were all calling cards for the disease. Clinically I already knew, but to confirm, I had her take all of the tests.”

They included blood tests and the test for rheumatoid factor (RF). All of them came back positive for RA. In fact, the RF titer was in the thousands. Her results all raised red flags and indicated the need for immediate treatment.

“I was in shock when Dr. Rodriguez told me I had rheumatoid arthritis,” Hammond admitted. “I did not even consider it in the realm of possibility because I am young. But when I was diagnosed, my fiancé read up on it and we realized I did have all the symptoms. I just didn’t see them.”

An aggressive approach to treatment

Rodriguez began her on methotrexate and pain relievers. He wanted to control the disease immediately and to improve her quality of life. While she was on these medications he discussed biologics too. He felt she was young and healthy and a prime candidate for biologic treatment that could give her longer lasting results.

They were both in agreement that they wanted to be aggressive in the treatment and help get her back to feeling normal as soon as possible. This was an especially pressing concern because her wedding was coming up.

“I was diagnosed in May 2012 and had my wedding planned and set for December,” Hammond recounted. “As much as possible I did not want to take the methotrexate and I was looking for a more direct treatment approach that could give me fast and long lasting results.”

“Because of her age and health, I thought she would be a good candidate for tocilizumab infusions,” Rodriguez said. “It would only be a once a month infusion and I felt it would be effective for her.”

He added: “I also chose this method of treatment so I could easily monitor her compliance. With oral medications, I knew she would sometimes pick and choose which medicines she wanted to take. At least with the infusions, I knew she was receiving the full treatment.”

The doctor and patient discussed the timing of the treatment cycle and Rodriguez asked her if she and her husband-to-be would want to try having a baby before starting the infusions. They decided that it could wait and Hammond began her first round of tocilizumab treatments before the wedding.

Infusions began in July 2012 after being on methotrexate for just two months. Both doctor and patient noticed a quick response to the biologic medicine. The pain began to subside and it eventually went away and both ESR and CRP slowly went down until they reached normal levels. In just six months of tocilizumab infusions, she felt much better and her tests had markedly improved.

“She responded very well to the first round of treatment,” Rodriguez said.

“I was really happy with the results of the treatment,” Hammond said. “I got married and was able to enjoy newlywed life with my husband who was very supportive throughout the entire treatment process.”

“There are definitely challenges to being diagnosed with RA at such a young age, but Hammond is handling everything admirably. She is cutting down on her stress level and is not allowing the disease to dictate her life. She is living life as normally as possible, which is definitely what every RA patient wants,” Rodriguez said.