So is the treatment working?

I've now been taking methotrexate+folic acid and hydroxychloroquine for 9 weeks.  The empty spaces in a blisterpack of folic acid mark progress, one for each week.  It's at this time you begin to ask the question, 'Is it doing any good?'.

A couple of months' back I asked my rheumatologist 'How would we measure improvement?'  At the time I knew that I'd posed the question in a rather nerdy way but it was the right question.  The answer came 'We gauge process clinically' (I presume this is about mobility and articulation).  Measurement e.g. by MRI scan would just be academic and even people with few clinical symptoms could show signs of inflammation on the scan.  Fair enough!

My current test is the ease of climbing the stairs at home, the first time in the morning, typically 40-60 minutes after I get up.  Sometimes I reach the bottom of the stairs and go to take the first step with my left leg and freeze with the pain.  Fast joint movement is not possible.  The step has to be taken slowly and even then is uncomfortable.  And yet later in the day, I can take two steps at a time. Ironically, if I get a better night's sleep, movement in the morning is more difficult.  Which to prefer good sleep or a pain free start to the day? Despite this confounding factor the stairs test is a good mark of progress. Even then sufferers of rheumatoid arthritis complain of flare ups: the disease and its treatment do not progress in a smooth fashion so it's harder to assess whether the situation is improving.

Another gauge is whether I find it possible to ride out of the saddle, i.e. 'standing' on the pedals.  In late summer this was not very possible.  More recently, particularly later in the day, it feels natural and comfortable.

Typically sources suggest benefits take 1-3 months to be felt.  In my case, I'm ramping up the dose month by month, 7.5, 10, 12.5, eventually to 15mg/week and taking blood tests every two weeks to check that there are no adverse effects.  So I won't even have stabilized on my final dose over the three month period,  Of course if my condition has improved should I put that down to the hard medication or to honeygar?

Why the title, Arthritis and Cycling?

As an exercise, cycling seems well-suited to people suffering from arthritis, second only to swimming.  The impact is low and there is no risk of over extension.  Bikes can accommodate a range of riding positions and gearing.

When my knees were at their most painful August time, the most difficult part of cycling was getting on the bike! And the cycling isn't pain free - sometimes my knees ache on every pedal stroke.

I've always cycled - atleast since my early childhood when it was a ticket to freedom.  My experience of cycling and sport has brought some of the mental discipline needed to manage arthritis.  A lot of the value I get from cycling is meditative. It's one of the periods of the day when I'm closest to my subconscious. 

Historically, I would be sensitive to such a warning, examining riding position, shoe cleats and possibly easing off. With arthritis I reckon that some discomfort is inevitable and is outweighed by the benefits to the cardiovascular system.  The paradox of arthritis is that while the limited and painful joint articulation deters movement but after prolonged periods of stasis, e.g. after sitting or sleeping, the joints set, making movement even more difficult.  Overall, I find life is much more comfortable when I'm moving which makes a desk-based job increasingly unattractive.  In fact I wonder how much deskwork was a contributory factor to my contracting the disease.