Heck, I took it upon myself to reduce my Plaquenil to one pill a day instead of two in hopes to salvage what little hair I have left. I almost considered taking enbrel every other week lol! Probably won't, but I totally feel you and don't judge it a bit!

Let me give a short history of symptoms...left thumb pain and old injured ankle pain, then chest pain going through to back. These were my early ra symptoms that I never attributed. From April to august 2013.

Then injury to left wrist August 15, 2013.

Then first flare September 9, 2013. First rheumy visit September 30, 2013.

Prednisone began sometime October 2013, had to wean older baby so started methotrexate Dec 6, 2013. Last dose December 20 and eliminated it from my body that weekend.

No meds but pred til December 30, and started arava.
January, towards the end, added Plaquenil.
April 2, 2014 added enbrel.

So now you see my history to help you understand my background. My medication and lack of medication. I've documented my hands and feet through pics since the flare Sept 9 (well since the injury on the wrist really).

My middle knuckle on the left hand middle finger has rotated to the pointer finger. It is now, the middle knuckle on the middle finger, it is facing partially the pointer finger. The knuckle since it's facing the pointer finger is causing the dip end to thus turn towards the pinky in classic ulnar drift form, though the drift isn't really noticeable to others, I can see it. It's minor drift. The knuckle...I showed the rheumy...and she saw what I saw. I compared it to early ra pics and it is different. I think it's a deformity. I had it while on and off prednisone for a few months now. You can tell if I lay my hand flat, the knuckle lines are not centered in the finger anymore. Now my right middle finger is doing it slightly. Since I kept photos I can see it is most likely a deformity.

We all know they can happen quick, but the question is does it *normally* happen quick, and in all practical purposes do we really need to worry about it happening quick.

I think mine was pretty effing quick. It isn't nonfunctining or anything, but a noticeable change in the finger structure.

To add, I'm seroneg on everything...even sed rate etc, and my vectra while on enbrel said I was in remission *eye roll*; but here I sit with slightly twisted fingers.

You need to decide if it's worth it to you to potentially wind up, different looking, from your stint ra drugs free for 3 months.

We can read statistics and literature til the cows come home, but sometimes personal experiences help. Please forgive the huge background, but I thought it may be beneficial in helping you decide. Good luck with the decision and feeling better!

I've seen my feet change shape little by little over a matter of a few months.
Oddly enough thought it would be my fingers but it's the feet/toes.
I'm stepping on my own toe now. Overlapping is best way to describe.
Been off treatment for few months sure that really helped it along.
It's your life Steph. No judgement here. As it's your choice & no one else's. Just be careful OK. This disease is unpredictable at times.
Yet we are all different there's no way of telling what the future holds. Even if we are speaking of just the summer here.
Good luck & stay safe.

Once every six months or so I get that thought to just forget it all and quit taking everything but vitamins. And then i remember the miserable few weeks when i had to go off some of my meds in preparation for shoulder surgery. And then I keep taking my meds!

You have to decide for yourself if it is worth it to you and how much you are willing to sacrifice for a tattoo.

And on the subject of tattoos - i am not positive that it is connected, but i have almost convinced myself that all my autoimmune problems started within a few weeks of getting my second tattoo. i have obsessed over it to the point that i have considered getting it removed. you might do some research on that before getting more ink?

It can be quick. My first x-rays showed thinning of the bones in my hands, which my then-doctor said can happen in as little as three months. A year later x-rays showed significant narrowing of joint spaces all through both hands.

Since you are possibly dealing with PsA, I'll pass along this link: http://psoriasis.org/advance/early-diagnosis-critical-for-psoriatic-arthritis It basically says that even small delays in diagnosis and treatment spell a worse outcome, less relief from drugs, etc. Now for me, that ship sailed long ago. Factor in a three-month wait to see an idiot, a month with that loser, a four-month wait to see the next one, a recent three-month delay to start a new biologic when my office visit had to be postponed twice (6 weeks each time to reschedule), and the fact that it took years to get a rheumatology referral in the first place . . .

What this article, and other information I've seen, doesn't address is the consequences of breaks in treatment. That's what you're really asking about.

Staying on the MTX might be a good compromise. You're doctor-hunting anyway, aren't you? Or did they just schedule you with someone else in the old office?

I am not responding to judge, but to hopefully provide some "wisdom".

RA can be very, very aggressive, or it can take years to do damage. We just don't know. You are going to have to live with your body for a very long time. Personally, I prefer to do everything within my power to try to ensure that I am healthy as possible for that long life.

I would rather live a life as pain-free as possible, rather than risk irreversible damage that would cause additional pain & suffering in my life, for the sake of aesthetics.

txtwinmom, even if we assume the act of tattooing or the tattoo inks triggered your RA, removing the tattoo wouldn't change that. removing a tattoo is a longer process with much more pain and much more healing.

my finger issues started long ago and have only gotten worse the longer i've been on medication. and me being on medication doesn't necessarily make me healthy. i'm pumping my body full of crap, putting a strain on my kidneys and liver... i'm not saying it isn't worth it, i'm not really arguing the benefit vs. risk - but you know.

going off all meds wasn't easy. the mtx does help a bit. i'm considering staying on mtx and just not going back to the rheumy for a new biologic until september... or maybe lowering my mtx. i don't know.

the tattoo isn't really just about aesthetics, it's not just about how i look. some of it's about control. i'm not letting this disease take control of my life, of who i am. i don't have a couple of tattoos - i have fair part of a couple of extremities covered, and plans for my entire left arm (shoulder to wrist), my entire back, my calf, and my thigh. i'm not letting this stupid disease take more from me than it already has.

i am fairly bed ridden intermittent without treatment if you want to use me as the canary in the mine.

I would think that some of the working folks on the board would point to treatment as a way to keep working and get a weekly paycheck.

i have enough pneumonias that i can point to 6 to 12 week breaks

but I just finished my first 5 month break in treatment - 3 month post neck surgery plus 2 months of insurance haggling and insurance crap.

i chewed so many nsaids and had so much IV antibiotic (post surgery pneumonia) that my liver got messed. so i ended up with the au natural thing + the NO biologic thing which meant more pain, greater swelling, new nodules, and entire new areas of failing in walking (ankles and feet) - my new insurance meant difficult to get into podiatrist but I am re-scheduled for in 3 weeks. i am expecting orthotics and injections. with my treatment regimes before going naked (sans meds) i had some control of pain, swelling and fatigue. some is good. some gives people intermittent respite or intermittent hope or joy.

I think if I was coming up on a mandatory break again I would lose it. I think I am going to wear a mask 24/7 when I am out, I simply can not bear to think of interrupting treatment again for a pneumonia.

You may be in a better place though. And i agree that this is your profession and calling - you will make the best decision for you.

Depot

Steph,
I started having an escalation in pain, etc a year ago, got me to the rheumy and officially diagnosed in November. Tried and failed first line meds so far due to side effects.I too was waiting to start biologics, me for the rationale that
they may have more serious side effects,cause me to become ill due to the lowered immune system plus with no confidence any one of them would work. I didn't want to embark on this until I could apply for medical leave/job protection in September. Guess I could say I thought better the devil I know-the pain and issues I've been managing that I know-than the devil I don't. It has not been good for me. Starting April new joints became involved and I'm more miserable than ever and its really effecting my ability to work and do anything in life since its moved to and settled in my hips and knees. I'm seeing a new rheumy soon and will bite the bullet and discuss any first line meds,maybe Mobic that has been mentioned, but biologics are on the table now.
I sincerely hope you're able to hang in there, please consider everyone's input and make the best decision for the disease.
I can admit I've had a small percentage of denial about this and chuckled to myself when I read your post since I was planning on skimming along this summer and not worrying about the biologics and getting serious until fall. With the horror stories about biologics and specialty pharmacies fall may still be my reality....
take care

Steph, from one inked to another - do it! You only live once - and it looks like you've tried quite a bit with little success already. Keeping a positive spirit is as important as meds in many chronic diseases. So if this helps your spirit - well heck you already know the RA risk.

Might be a time to research eastern medical treatments. Maybe try some. One reason western medicine frowns upon eastern is that it uses herbs and the human mind. Two things western med can't patten or put in a bottle. Billions of people use these treatments with varying degrees of success. Maybe your magic bullet lies there? And with the internet, PayPal and FedEx - you can access the herbs :)
If you don't find your magic bullet - you're seeing your rheumy in the fall anyway...

Good luck!

i'm actually planning on starting acupuncture soon - my cat's been having acupuncture (catupuncture) for about 5 weeks now - and i realized it's stupid that i'm not having it. my husband too. if we can swing the cost, i'm hoping to add monthly massages back in, too. we used to have regular massages and i feel like it really helped our collective back problems (we've both had multiple herniated discs from multiple car accidents). i don't think i would be comfortable adding chinese herbs to my diet because there is not a lot of research on how they interact with my other daily medications.

it's just frustrating to know that none of the biologics i've tried already have done jack, and i don't know what the chances of the next round are working anyway. i know for many people mtx seems to help enough to stop the pain and slow the damage; i know it helps my pain a little bit, so i'm assuming it slows my progression a bit. i don't know, sometimes talking (writing) things out helps me sort out my thought process. and i do value other people's opinions.