Do we really need the drugs? Or do we need more scans

I know what my feelings are towards the drugs they would have us take in order to slow the progression of the RA down, But apart from asking us how we feel when we see the consultants how are they monitoring our body's. Through the ESR/our feedback you might say well that's not conclusive evidence you can have a low ESR reading but still have activity feedback can be vague, i should know because i had lets just say a heated discussion with both Consultant and Doctor about this and guess what they both agreed. My point is unless we have x rays, mri scans that can see the damage on maybe a yearly basis how do they know how fast/slowly the RA has progressed. Before you say it i know they dont like giving to many x rays but with todays technology mri scans should be used a lot more.

Any thoughts

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  • Zimmie, I understand what you are saying, in fact inflammation does not always show on xray, MRI is more precise. My feet & hands were xrayed on initial diagnosis, presumable for comparison later on (3 years ago).

    There is a new report out , which has proved that the sooner you start DMARDS ie. within 12 weeks of onset, the more successful the treatment is, which means there is a window of 3 - 6 months, to treat aggressively with combination DMARDS into some sort of remission ( bloods ESR CRP normal) That is why they are trying to fast track RA patients to consultants these days!. I don't know about you but most people are'nt diagnosed for a lot longer than that, blood tests are only ordered after about 4/5 visits to GP. There is also another new study providing guidelines on the diagnosis of remission in RA. I think I saw this on the U.S Rheumatoid Warrior on FB.

  • hi, yep xrays, my concern radiation risk!!!!, have had a few in my time!!, they were on a bout re xraying me one year in in said no, mad you say?, well two yearly I think!!? says some one in her life time who amoungst xrays has had 2 ct xrays and 2 chest xrays as well as hand, feet. knees and spine, they way I am going in could be at increased cancer risk!!, my hand damage on diagnosis was only clear on ultra sound!!!, ct and chest xrays carry a much higher doses of radiation than other xrays, my hosp wont pay for MRI even though they have two scanners, one in the building and one one a trailer(lorry) the lorry is parked out side near the pharmacy were I work off poorly at moment

  • It's this sort of think that worries me with cuts to NHS, as may mean that doctor's have limited room to choose themselves what you need and just have to follow the "rules". If having scans helps someone mentally feel stronger about RA and more positive then that's a good reason to me. But the NICE guidance doesn't mention using MRI on annual basis so I guess the cost has ruled it out. But it is clear that we should be getting the aggressive early treatment approach. It's on web at nice.org.uk/CG79 if you want to have a look. I'm not so worried about xrays & radiation as it's hardly more than you get every day, and I thought even most CT scans were ok every year or so - just don't want too many of your torso. But yes, much better if we could have MRI's!

  • Hi!

    X-Rays, MRI, CT are generally considered very safe these days. Used regularly they would soon become a very expensive burden on the already failing resources of our NHS. They are also unnecessary. No amount of 'picture taking' is going to help with disease control. Most early stage RA will not show any joint damage by any means, that's actually the point of aggressive DMARD therapy at the outset ... avoidance of joint damage!

    Modern drugs do, on the whole, work for most people. Okay there are some stubborn cases that don't respond to treatment but they really are in the minority. Progression of disease pattern is, or should, be done by looking at a patient as a whole, and not the odd joint here and there!.Blood tests give only a very small part of the overall picture.A hot swollen joint is a better indicator alongside pain and fatigue. If these are regular features of ones RA the disease is not controlled and you are at risk of joint damage. Controlled disease is fairly 'symptom-less'. That said we all 'flare' at times due to physical and emotional stresses, environmental factors, general illness etc. Such flares can be easily brought under controlled if action is taken immediately.

    Whatever medication you take the disease will progress, it cannot be cured, it cannot be halted. Remission, and therefore control, is a DAS of less than 2.6. (see my blog on DAS!!). This takes account of a range of factors that determine disease activity. So, I am sorry but I have to disagree on this one ... in my opinion, Scans and X-Rays are not the way to determine disease progression only joint damage at any particular point in time.

    Lyn x

  • The only x-rays I have ever had done on my hand and feet joints were commissioned by my GP 10 years ago and nothing since. I wonder what condition my other joints are in. When I lived in Wolverhampton they started giving me yearly chest x-rays after I started the TNF's but not now I have moved to Leicester. I must admit I did worry about yearly exposure to x-rays but would like to have some sort of check every 2 or 3 years. MRI sounds like a good idea. I think a lot of it is down to budget.

  • Yeah but.... take me or instance... so to be selfish again. I have had swollen joints on and off for 10 years. I obviously had a full blown flare in October. I did not get any medication at all ( I had to stop the Diclofenac beg of Nov because of side effects) for it until December 28th.. So much for getting at it early and stopping or avoiding the damage. I can see now my hands have gone down that my knuckles no longer look the same, like my knees. i have only ever had x rays. The point I make is, I think the MRI scans would let you see how much damage you have, and bloods don't always tell the full story... or am I missing something?

    Yes Shelly you re so right. It's all down to money. You get what you local NHS or Doctor can afford, not what you need.

  • yep its money moeny money its not so funny in a rich mans world , gimme gimme a man after midnight!!. any one up for a virtutal abba party with silly flares!!!! ,and head bands

  • Hi. have to say in my opinion anyway its all about early diagnosis, having waited almost 12mths for mine it was too late, and then I was only given sulphasalazine as not much was available then not like there is nowadays. Damage already done! the RA then got ahead of the drugs if you like and as they have to wait three months then for them to take effect you just had to wait. At the end of the day no amount of scans MRI or otherwise would have made a difference.

    mand xx

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