I have a Rheumatology card where you can actually ring in if you're having trouble with your RA and there's an injection clinic, where you just can turn up on a Friday, you know they can just book you in there, there's no waiting for it, so you know what I mean, if you have joints which are regularly troublesome you can pop in and they can put a cortisone in or whatever. So they're pretty good.
So do you feel quite involved in the management of your RA?
I do feel yeah now definitely. Yeah, especially with finishing work it's made it a lot better, mana, sort of managing it really. I feel a lot more comfortable with it, before that I couldn't come to terms with it at all really.
Do you like I was going to say, the fact that you can just ring up and sort of take a bit of control yourself?
Yeah it does help you really, especially if you're having trouble with a joint like, as I said me two shoulders, me shoulders were bad and I was having a lot of problems even just cleaning me teeth, brushing me hair, just trying to move me hands round the back there, you had to try and shift them, it was, it's weird like trying to explain to people like right, it's just sort of day to day stuff and you just, the pain is incredible, so to pick a phone up and to just explain to them down the phone and they say 'Right not a problem like right, come in on Friday such a time like right and we'll put some cortisone in them'. Put some cortisone in and two days later you feel super human again like basically. Yes, it's pretty good.
Maintenance therapy with either azathioprine or methotrexate is initiated if remission has occurred after three to six months of induction therapy. Steroid dosage is tapered during this phase. Patients may need to continue maintenance treatment for up to 24 months. 24 Maintenance treatment for up to five years is recommended in patients with Wegener granulomatosis and patients who remain ANCA-positive. 19 Some patients may require treatment indefinitely. Disease relapse may occur anytime after the remission. Serial measurements of ANCA are not closely associated with disease activity; therefore, treatment should not be solely guided on the basis of an increase in ANCA. 25 Relapsing disease can be managed with an increase in steroid dose, optimization of the current immunosuppressant, or combination of an immunosuppressant with an increased dose of steroid.
As in previous versions, the Task Force endorsed the presentation of general principles for the treatment of patients with RA as overarching ( table 2 ). Their nature is so generic that there was no requirement to base them on specific searches or LoE, but at the same time the group believed it is crucial to communicate them as a foundation on which the actual recommendations were based. However, while all three former overarching principles were maintained as formulated in 2010, the Task Force added a fourth one as overarching principle B.