The legal issue continued...

If I do not take a biologic, my lawyer is advising a note from my doctor listing the reasons in support of my denial to take them. I don't know if she will do that. I might be able to get a different doctor to write a note, however he only saw me three times (I couldn't afford his rates). He is a Chinese PHD who specializes in acupuncture, herbal treatment and massage therapy and who is against the use of biologics.

Even still, every doctor has stated that my condition was exasperated by work, as I had no indication of RA beforehand. Either way, isn't defense responsible for the work that caused the injury?

I now understand how mitigation works, but I have questions (if you don't mind)...

1. Suppose I give-in and try a biologic. Is defense liable if I have a negative reaction, or will I be expected to go down the entire list of biologics hoping for one that works?

2. What if the one I try works wonderfully, but I am still unable to work?

3. What if I can go back to work, but the biologic wears off within months? Then I'm back to square one? Or even if I'm in remission for 10 years-then no compensation?

I see the bottom line as being that there isn't a drug in the world that will cure the RA. Remission happens, but not for all (I won't know unless I try everything?). I understand that it was the work which brought the RA to the surface sooner than it probably would have occurred, and I am a bit resentful for having had this happen. I also resent being given an ultimatum that compromises my beliefs.

All of your reply's have been wonderful, and I thank you. I can see both sides of the argument and that's what makes it difficult for me to decide what to do.

Any further comments or answers would be greatly appreciated, as my attorney is quite worthless.

Thank you!

[Hidden]

I can't comment on the legal issue. But I think it's a shame that the position you're in is making you evaluate biologic drugs primarily in terms of how they might influence the outcome of your claim.

It seems to me that if you are completely against biologics then you shouldn't really take them. Perhaps I'm wrong, but starting a new drug regime under duress sounds like a recipe for trouble.

There again, starting a new treatment that you've heard good things about, feeling reasonably confident that it'll protect your body from the worst of the disease and will help get your life back on track bodes well for success.

I would not take a drug I thought was really bad news under any circumstances. However, that's not how I feel about biologics. Here in the UK many suffer because the high cost means that they are not available to all who need them. I'm one of the fortunate ones.

[Hidden in reply to Hidden]

I do find myself wavering just to pacify the defense. Am starting to research every biologic/ingredients to either back up my fears, or to perhaps try one to mitigate their claim. Thank you for your input.

How do you like biologics and which one are you taking?

[Hidden in reply to Hidden]

I'm on humira. I was in very poor shape by the time I was diagnosed with PsA and it was a long-time coming, during which I felt more and more wretched. I think sometimes the harder it hits you, the easier it is to reconcile yourself to a life of taking meds.

I realise that there are risks with drugs and it's not always easy to know how much risk is involved. Plus the internet can be one long horror story. But quite apart from the impressive improvement in my joints I feel and look healthier now than I have done for perhaps 10 years. That in itself helps allay any fears I may have.

My dermatologist said something simple about biologics but I found it interesting. It was basically that they are not 'stronger' than the DMARDs, but smarter, more targeted at specific parts of the immune system.

I'd never say 'just take the drugs!!' It's not like that, everyone has to weigh it up for themselves. But before starting treatment I had anaemia of chronic disease and high inflammation levels. Uncontrolled inflammation scares the hell out of me. So now that is under control I squirrel that away as being one indicator that my general health is 'safer' than it was before Humira rather than at risk.

Incidentally, like a lot of people I think that overwork as well as probably quite a few other 'triggers' decided the timing of the disease.

Good luck whatever you decide to do.

[Hidden in reply to Hidden]

Thank you. I am considering Humira, although I'm not happy about it.

[earthwitch in reply to Hidden]

In some ways I think you might be better off researching evidence for work activities triggering (or bringing forward the onset) of RA. It is always incredibly difficult to win a claim for work related injury when you have a known disease process going on, and they could well argue that the work activity was coincidental and you would have got RA at the same time you did, whether or not you were doing the work. If you could find concrete (validated) research evidence that the type of activity you were doing can trigger RA, and if there is evidence of how much earlier it could happen, then that might really strengthen your claim. I would guess too in addition to compensation for the estimated time between when your RA was triggered by work and when you would have got it naturally, that they will only be compensating any current and ongoing disability (relating to the work-related activity) that remains once the underlying disease is treated adequately, which is why they seem to be insisting on you taking the anti-tnfs .

Another tack you could take on this basis is to provide evidence (from inflammatory marker blood tests or xrays, etc) that your RA is actually clinically under control, therefore your current treatment is as good as it will get without adding anti-tnfs.

(note that these comments come from my personal experience of a work related injury that was complicated by an at the time undiagnosed condition, although it was in another country).

[Hidden in reply to earthwitch]

Thank you for the very good advice. I am in the US and work comp is notorious for not wanting to pay anything. Your input will help keep me on track.

[kalel]

the problem with biologics is that they can work very well for some people and they don't work for others as well. Also my understanding is that most people take a mixture of drugs like methotrexate and then a biologic.

On a personal note I have tried taking two biologics humira and simponi. Humira worked for me for a long time and then it stopped working. Simponi did not work very well for me and then I was told by my Dr that Simponi is normally given to people that have less inflammation going on in there body than me and have problems injecting themselves.

Anyway long story short I am now seeing a functional health practitioner in the UK and am trying to find a functional health practitioner in the USA.

Good luck with everything, all the best.

[Hidden in reply to kalel]

I know that the drugs work differently for everyone. I had a bad reaction to methotrexate and most of the other dmards. I'm on sulfa/methylpred now and am doing ok, but am afraid that if I get off of it for a biologic (which I'm not comfortable with anyway) and have a reaction, will I do as well once back on the sulfa again?

Thanks for the input. Good luck to you as well!

[kalel]

I did not realise that you where already taking medication.

Just be careful in regards to taking steroids for a long period of time.

If the medication is working for you then I don't see why you would change the treatment that you are on but I am not a DR.

If you lived in the UK and the medication that you are currently taking is working for you then they would not change the meds that you are on to biologics. The reason why, as far as I am aware patients are put on biologics in the UK is because other drugs have not worked for them.

The way medication is handed out in the USA is very different in comparison to here in the UK.

So if I where you I would talk to a DR about things.

Good luck with everything.