Time, tide & inflammation waits for nobody…

I recently blogged about the ‘drug free remission’ in Rheumatoid Arthritis.
Aggressive treatment with DMARDs, biologics & a targeted approach can help one achieve this.
But, is it really that simple? For the best results, what would one expect from Patients? Positive approach & compliance……
But, why am I thinking about all This?

Last week, I was going through my OPD appointment list. One of the names looked familiar; Mrs. K, but I could not recollect the patient.
A lady in wheel chair, with most of the joints swollen was brought in by 6 of her relatives! She was unable to walk on her own. As I went through her file, history unfolded.

I had seen her some two years back. A lively young lady, a doting mother had consulted me for her joint complaints. She did have rheumatoid arthritis & was started on DMARDs. She was given three DMARDs due to the high disease activity. However, unfortunately she continued to have persistent joint inflammation even after 6 months of therapy.

The inflammation then started interfering with her personal & family life as well. Frequent leaves were ruining her professional reputation, her son was doing badly at school & there were frustration & fights at home.

We were slowly moving towards a decision of starting biologics. The entire issue, need of biologics, effects, side effects were discussed. The family was alright with the idea of a more potent drug to control the inflammation, but wanted to wait for some more time. We waited for two months, DMARD doses further optimized; but in vain.
After three months, I discussed the issue again. However, they were scared by a pharmacist relative about the side effects of biologics.

That was the last I saw her then. Now, she started telling me what happened after the last meeting. She & her family were scared of the side effects of biologics, decided to try alternative medicine, stopped all her allopathic medicines. The Result? It was staring at me……

A crucial mistake of stopping all DMARDs at a crucial juncture had done a lot of damage. Her knees were badly damaged & hands were deformed. Time, tide & inflammation does not wait for anyone…..uncontrolled inflammation had inflicted enough of damage already & quite a bit was irreversible.

Suppose you are caught in a similar situation wherein you have to decide regarding a biologic/ new therapy advised by your Doctor, how would you go about?

Decision making made easy

Decision making made easy for patients

A few points to remember —

1) When you go for a second opinion, if the second consultant confirms the proposed line of treatment, go back to your primary consultant who already knows you & your disease. The second doctor would take some time to understand your arthritis & establish his own treatment strategy.

2) Use the internet, get more information. Be judicious in the choice of sites. You can also use the social media to connect with specialists & other patients to learn from their advice, experience.

3) Never stop the ongoing treatment in the mean time. Never go for the radical option of stopping all the medicines without medical advice.

4) Always know when to put a ‘stop- loss’ order. What is this ‘stop loss order’? It simply means that, you should know when to stop wasting time in taking crucial decisions. Your decision & the plan should not take more than 4- 6 weeks (preferably).

Let us not realize that ‘Time, tide & inflammation does not wait for anyone’ the hard way.


  1. I’ve been following a conversation on a support group where the woman feels that with multiple health problems she would choose not to obtain RA treatment because it may make other diseases worse.
    She has had 8 responses in one day unanimously telling her that she should base her decision on what the doctor tells her to do, mentioning results of untreated RA, hope for remission, getting opinions from all of her specialists. One tells her to face the “what if” versus the reality of the situation.

    RA is worse than the medications.

    That’s good practical advice on the second opinion. Good to know the right procedure from your point of view



  2. Yes Doc,Time, tide & inflammation waits for nobody…I am the living Example for taking biologic Treatment,Apart from some few Doc more than 85 percent doc opp. biologic treatment,its happened most of the small cities like Aurangabad.More awareness is very imp abut Biologic from Doctor side, from pharmaceutical company and society also!



  3. “Let us not realize that ‘Time, tide & inflammation does not wait for anyone’ the hard way.”
    A very valuable statement for all of us. To be remembered always.
    Thank you Doctor for all your inputs, they all help us to deal with our disease in a better way.



  4. Hi this story strikes a chord with me. I was put forward for Embrel when my RA became severe. I am an active 51 year old and try to keep as busy and as positive as possible as i find being upbeat keeps me going.

    None of my joints at the time of being put forward for a biologic were damaged. I am a pianist/piano teacher/horse rider and was keen to get on the drug asap.

    I looked into the side effects but realised the positive effects far, FAR outweigh them.

    Alas..Just in the 18 months, whilst being evaluated for the drug, my right hand became quite badly deformed. Embrel is working a treat now so far, but due to the wait for the drug (and my rheumatologist jumping through hoops in order to get the drug through,) my piano playing has now become more limited and difficult. I am taking 10 mg Methotrexate also, to boost the Embrel.

    Its so heart breaking but i am only glad that the rest of my joints are more or less free from damage. Please, PLEASE don’t delay getting on this drug if you are put forward for it..it quite literally gave me my life back.




  5. Dear Doc,

    Thanks for this blog. A very valuable advice to all who are recently diagnosed to suffer from RA.

    My wife is suffering from RA for last three and a half years. For some time we have been managing the disease with DMARDs. However, after a couple of years it was noted that the DMARDs were not acting effectively. At this point it was decided to go in for biologics after taking due precautions with regard to susceptibility to infections. After a course of 12 Enbrel injections her joints pain almost completely disappeared. Because of the efficacy of Enbrel treatment the pain killers could be stopped and her general sense of well being improved to a great extent.

    I have read lot of medical information on the use of biologics and can very confidently say that the good effects are far too superior to the bad ones. Because of compromised immunity the patient needs to take care that he or she is not over exposed to unhygienic conditions. Done this biologics are very safe and will go a long way in bringing about remission and restoring normal life.



  6. Thank you Doctor ! After total knee replacement of my wife I was wondering if the RA medications are necessary. But yourself and also Dr. Bhonsle ( who performed TKR) explained that TKR has solved the mechancal problem of knee joint and pain joint due to Osteo Arthritis only. RA is still there in other joints but it is well controlled with DMARD. So treatement for RA has to be continued. She is enjoing a better quality of life with TKR and DMARD treatement. Apart from this during the last three years medication was never required to be increased. And all other parameters tested in blood test are normal. Thanks agin for such good article and cautioning patients about discontinuing treatement.



  7. I agree sir. Finding a good doctor is tough but trusting is even more tougher. But once ppl start trusting their doctor they start feeling better sooner than others.
    Nice and helpful article.




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