Hey, it certainly does feel like a slap in the face! You're going to be come very familiar with pharmacology over the next few months, trust me!
The next step for you will be to explore better NSAIDs, voltaren sounds like a trade name for Diclofenac to me, if you're taking less than 50mg/dose then see about
getting on the 50mg tablets as they do provide a lot of relief from inflammation for a lot of people.
Alongside this, you'll be looking into starting a DMARD, which is a Disease Modifying Anti-Rheumatic Drug, these are not pain killers but are drugs designed to reduce the mechanism which causes RA, which you may or may not know is caused by an excess of a chemical called TNF-A (Tumor Necrosis Factor Alpha), which results in joints swelling up as an immune response. The mainstay for this is Methotrexate (usually abbreviated MTX), it's very effective for many people, but unfortunately does have some uncomfortable side effects for some people, which can be minimized by injecting into the stomach/leg rather than the tablets (dose is usually once per week). If you go down the MTX route then you'll also probably start taking a 1-5mg Folic Acid supplement too, as MTX can cause a FA deficiency. MTX also has the advantage of being a very cheap drug, which may play a part if you're from a country where healthcare isn't 'free'. A good alternative to MTX for those who can't tolerate it is Leflunomide. (you may hear of these drugs being discussed as different names, as many have various trade/generic/chemical names)
Other DMARD options you'll be looking at include Sulfasalizine, Hydroxychloroquine (an anti malaria drug, actually, but also works for RA - put my sister into remission for the last 5 years!), and a large variety of others, geography and your doctors preference do play a large part in the route you go down.
The most powerful/effective treatment for most people is Anti-TNF therapy, (these are still DMARDS, but are a sub-class of them) which is basically a chemical or synthetic anti-body which binds to the TNF-A in your body and reduces its effect, these are usually a self-administered injection, or an infusion given at the hospital. They do come with some risks (increased risk of infection), and they are extremely expensive (We're talking £10,000 GBP, or $15,000 for a years supply). Google Enbrel, Remicade, Humira. I currently inject Enbrel once weekly, and find side-effects to be minimal, mainly just tiredness the next day and a few more colds than most people!
If you're unlucky enough to not get the pain under control from the various treatment options above, then you'll be looking at some more potent pain control as an adjunct, basically the opiates. Codeine and Tramadol would be the usual starting point (in fact I suggest speaking to your doctor about
getting some Co-Codamol 30mg/500mg or some 50mg Tramadol now, it should help). Following that, you'd be looking at Hydrocodone (Vicodin), Oxycodone, etc.
Alternative treatments - I wouldn't bother wasting your time, there's a reason they're called alternative, and given you have RA, you need to be cautious of certain treatments - heat therapy can be a bad idea if you have RA, and given the cocktail of prescript
ion meds you're likely to be on, taking strange chinese medicine concoctions could be potentially dangerous. There is one herb which is very useful in safely alleviating RA pain, however.
Also speak to your doctor about
getting a steroid shot (co-cortico), this will take a few days to kick in the first time you have one, and you will probably feel great for a good few weeks after it. These only last so long before they become ineffective though, so enjoy it while it lasts. Before I started MTX I basically lived by having a steroid shot every 6-10 weeks.
There are other pharmacological options for treating RA, including anti-biotic therapy and the steroid Prednisone (which is still a DMARD, but with a relatively different mode of action to the rest). If you're unfortunate enough that your RA progresses and causes damage, there are many surgical options which provide a lot of relief, but I doubt you need to be thinking about
that now.
I'm not a doctor or anything (so don't interpret any of this as medical advice, rather as some knowledge to arm yourself next time you see your dr), but after a little while of living with RA/PsA/etc you kinda become a walking medical dictionary for Rheumatology.
Regading your sed rate etc - it is reasonably common for people to present with RA despite completely normal blood work up. My doctor told me that with blood like mine I should live forever! On paper I am very fit and healthy, but in reality I'm often a wreck! (My family joke that I'm extremely healthy for a very ill person!)
Sorry if I've repeated anything someone has already written, but I didn't have time to read every post, there are some very helpful people around these parts.
Oh, and if you haven't already, get a Rheumatologist and don't just be treated by a family doctor or general practitioner.
You will probably also need to learn how to count your spoons - see http://www.butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory-written-by-christine-miserandino/
good luck and welcome to the forum!
[Edit - Edited for terrible grammar given it's 3am and I'm tired having just got in from work, I'm usually much less illiterate.... I hope!]
Post Edited (JayBespoke) : 11/27/2010 8:13:40 PM (GMT-7)