It started in January 1986 when Esther Wei, NP, came home from her honeymoon in China. The initial symptoms that Wei felt were pain in her feet, which she attributed to the touring that she did in China. As the pain got worse, Wei noted that her metatarsals became tender and swollen. It became so uncomfortable for the nurse practitioner from New York City that she was limping.

At one point, Wei was taking a NSAID medication and the symptoms came and went. Then the pain got really bad on a trip to the Bahamas with her husband. She had a memorably bad flare.

“When we arrived, I could barely walk off the plane,” recalls Wei. “I could not do much vacationing because my feet hurt too much.”

While visiting family during the Thanksgiving holiday, she had a flexion contracture on her right elbow and was experiencing joint pain in her knees and temporomandibular joints. Wei even had a hard time opening her mouth. While the symptoms had become worse, they occurred gradually so Wei did not think much of them.
However, when Wei visited her sister Debbie, she insisted that Wei discuss these symptoms with their brother Nathan, a rheumatologist. Dr. Wei diagnosed his sister with rheumatoid arthritis (RA).

“It was pretty wild,” recalls Wei. “The only relative in our family who had RA was a great aunt who had severe, deforming RA. I did not like to think about it.”

Despite having RA, Esther Wei, NP, continues to have a positive outlook and runs whenever she can.

Lab results confirmed Dr. Wei’s diagnosis. On the suggestion of her brother, she went to see Stephen A. Paget, MD, FACP, FACR, at the Hospital For Special Surgery in New York City.

Wei was treated with nonsteroidal anti-inflammatory drugs (NSAIDs) but had difficulty. She became allergic to ketoprofen and diclofenac sodium, and added that hydroxychloroquine sulfate did not work. Wei says she developed pancytopenia after receiving gold injections.

Dr. Paget wanted to start intramuscular methotrexate treatment but Wei declined the treatment. She wanted to get pregnant and was afraid of the possible teratogenic effects with methotrexate.

During her pregnancy, Wei was occasionally taking prednisone and her RA into remission. In fact, Wei felt so good during this time that she recalls taking aerobic classes up until three weeks before she delivered her son.

However, three weeks after giving birth, Wei suffered a bad flare attack to the point where her elbows became too swollen and painful to pick up her infant. That day she went to have her elbows tapped and injected with corticosteroid. Wei realized she had to renew her commitment to treatment for her RA. Three months later (after she had weaned her baby off breastfeeding), Wei started taking methotrexate. Still, she had intermittent flares now and then.

Wei moved on to etanercept and notes that it worked well for a couple if years. However, she had a major flare two years ago.

“It was affecting my hands and this was a first,” notes Wei. “I freaked out because I was having a hard time doing my job. I could not use the computer or pump up a blood pressure cuff. I was up to 60 mg of prednisone a day.”

After experiencing another serious setback, Wei was told to decease her use of steroids and she is now taking adalimumab in combination with methotrexate. She notes that she had a couple of flares in eight months and has required steroid pulses on two separate occasions. Wei says she may need an increased dosage of adalimumab or perhaps some other change in treatment in the near future.

However, despite the challenges of living with RA, Wei has a positive outlook despite the obstacles. Prior to developing RA, she was an active runner. Wei continues to run when she can, having completed seven New York City Marathons. Mostly though, she is happy for the family she can lean upon.

“I am grateful for many things like having a supportive husband and being lucky enough to have a wonderful son,” emphasizes Wei. “I am also lucky to have a brother who is a rheumatologist. If he had been a cardiologist or neurologist, where would that have gotten me?”

Wei says she is thankful for having a “top-notch rheumatologist” like Dr. Paget, who is always available to her, and the new research that is being done to try to cure her condition.

“I am especially grateful for the research that yielded the medications that have allowed me to continue with my life and do the things I love to do.”