PP19: Living with Rheumatoid Arthritis in a Rural Farming Community: How I Found a Rheumatologist and Got Targeted Treatment

Vanessa Kerr, Mexico, MO

Background/Purpose: I'm Vanessa and I've been married to James, a farmer, for 27 years. We have 5 children and when my fourth was born, I found myself too weak to pick her up from her crib. When I did, it left my hands, arms and shoulders and aching to the point that I'd walk around holding them up and crying. I went to my family physician who thought it might be Rheumatoid Arthritis (RA) and he referred me to a local rheumatologist. He was only available once a week and never able to test me while experiencing symptoms, so I kept getting negative results; however, he thought it was RA and gave me a prescription.

Six years later I was in remission during pregnancy with my fifth child; however, after the birth my rheumatologist moved, and symptoms returned. It took 6 months to find a new rheumatologist. She doubted my symptoms; luckily blood work confirmed my RA diagnosis. Unfortunately, she was only available once a week and appointments were difficult to get. She placed me on a DMARD along with steroid shots during flare. Despite the steroids, which made me feel anxious, there were times that I couldn't work and my family had to help me dress. My rheumatologist never discussed treatment alternatives.

Intervention: My cousin, working in autoimmune research, suggested I seek out a proactive rheumatologist. Finding a substitute teacher to cover me for the day is hard, so I wanted a physician who is close. I found a rheumatologist about an hour's drive away who said my medication was not working and changes had to be made. He stopped the steroids and placed me on a biologic along with my current DMARD. My symptoms improved dramatically. I was given a direct line to the nurse resulting in quick response times when flaring. The office is open four days a week and nurses are available on the fifth day to order refills and convey special needs to him.

Maintenance: During the COVID shut down I met with my rheumatologist via Zoom. Despite me getting COVID twice during the pandemic, my rheumatologist was readily available for medical advice. Controlling my RA has been difficult due to other health problems. I had COVID pneumonia, further weakening my immune system and leading to hospitalization with Legionnaires Disease with a CT showing a mass in my right lung. My rheumatologist and pulmonologist are now consulting after the next CT to see if it is related to my DMARD use.

I've switched up my diet to include more fruits and vegetables and fewer carbohydrates. I stretch in the morning to help me get past the stiffness quicker and try not to sit for too long. I set a goal of some physically challenging event making me plan exercise. I will be starting weightlifting per my rheumatologist's recommendation.

Quality of Life: Living in a rural area has taught me that advocating for myself is important. There is no rheumatologist in my town and the local hospital has closed. Rural health care is increasingly difficult to navigate. When going to physicians, it is extremely important that I write a list of each of my concerns and bring someone with me. James has spoken up on things he feels that I am sugarcoating. I remember that I know my body, pain level, symptoms, and what is working for me. If I feel my concerns are being dismissed, I say so or look elsewhere.
Figure 1. Challenges with Rheumatoid Arthritis in a Rural Community
Disclosures: V. Kerr, None.