This article is more than 5 years old. Information may no longer be current.
Should I Stay or Should I Go?
Click Here to Manage Email Alerts
In reading two of the featured articles in this month’s issue of Healio Rheumatology, I was reminded of the 1982 song Should I Stay or Should I Go by the iconic British punk rockers The Clash. The song is surrounded in mystery. It poses a dilemma that we are never exactly sure of something’s nature. It also reminds me that in the world of rheumatoid arthritis, we face many dilemmas — some of which are also complex and shrouded in mystery.
Discontinue or Taper
In “Experts Discuss the Quandary of Whether to Discontinue or Taper Treatment and When,” Paul Emery, MD, and T. Martjin Kuiper, MD, among others, discuss the dilemma of ongoing (ie, lifelong) therapy in an era where it is increasingly more common for our patients to achieve remission. Wouldn’t it be great if we could seamlessly pull back therapy in well-controlled patients with confidence that they would not flare in the future and we are not allowing unbridled systemic inflammation with potential serious adverse effects, such as subclinical vascular disease progression, to continue?
Many clinical trials have shown tapering is possible and some clinical trial are also providing evidence of biomarkers, such as multi-biomarker disease activity and anti-citrullinated protein antibodies, to help us decide. However, not all studies are in agreement and we need better predictors. Not only do patients not want to take lifelong medications, but the costs are also increasingly problematic in terms of trying to justly distribute health care resources. Virtually all are in agreement, however, that stopping therapy is both impractical and imprudent in most situations. We clearly need to stay in the arena of indefinite treatment for most patients with rheumatoid arthritis (RA).
Sex and Intimacy
In terms of considering the issues of sex and intimacy in patients with RA and indeed any segment of our rheumatic disease population, I am guilty of not actively engaging my patients in such conversations. I should ask myself “why” given that I truly value wellness in my patients.
© 2017 iStockphoto.com/dimitris_k
By wellness, I do not mean health for we cannot make RA go away. More importantly, I am referring to the diverse and interconnected dimensions of the physical, social and mental well-being that extends beyond the traditional definitions of health. Who would argue that a healthy sex life is not integral to such wellness? Yet we are reluctant to engage for many reasons as discussed by our outstanding panel in “Unspoken and Undiagnosed: Addressing Sex and Intimacy in Rheumatic Diseases.”
Focus on Wellness
Sometimes when there are tough topics on the table, we are reluctant to bring them up for discussion. This could be a grave diagnosis or test results, a complex psychosocial situation or exploring the details of a sexual history. The answer is to stay and lean in. We may be temporarily uncomfortable in such situations, but we must remember that we will be okay when the encounter ends.
Our patients will not be whole if we do not actively engage and help our patients traverse these tough issues. We can no longer be satisfied with merely achieving disease activity score remission. We must increasingly focus on wellness, too.
Thank you for reading this issue of Healio Rheumatology. Please email me your comments as well as topics for future coverage at calabrl@ccf.org. Follow me on Twitter @LCalabreseDO and @HealioRheum.
- Reference:
- Haschka J, et al. Ann Rheum Dis. 2016;doi:10.1136/annrheumdis-2014-206439.
- For more information:
- Leonard H. Calabrese, DO, is the Chief Medical Editor, Healio Rheumatology, and Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic.
Disclosure: Calabrese reports he is a consultant for Genentech, Pfizer, Bristol-Myers Squibb, GlaxoSmithKline, Sanofi, Jansen and AbbVie; and is on the speakers bureau for Genentech, AbbVie and Bristol-Myers Squibb and Crescendo Bioscience.