The Young and the RA

As the latest and greatest drug, a lot of people out there are on biologics. Biologics are a class of drugs used to treat inflammation.  According to the American College of Rheumatology:

“A “biologic” drug copies the effects of substances naturally made by your body’s immune system. Biologic agents are genetically engineered drugs – meaning that human genes that normally guide the production of these natural human immune proteins (i.e., an antibody to TNF) are used in non-human cell cultures to produce large amounts of a biologic drug. These drugs are given to lessen inflammation by interfering with biologic substances that cause or worsen inflammation. These new biologic agents can specifically affect some of the abnormalities of the immune system that lead to the joint inflammation and other abnormalities seen in rheumatoid arthritis and so help treat its symptoms.” 

This class of drugs includes Enbrel, Humira, Remicade and several others. They are taken either as a shot — some can be taken twice a week and others every two weeks — or through an IV — while taken only once a month or so, takes several hours and you have to have a health professional set it up. I have only tried Enbrel and Humira (which I am currently on), so I haven’t done the IV before.

I have heard stories about people experiencing improvements immediately after taking the drug, but it didn’t take effect for me for several months later. And I have talked to several people who had very adverse reactions to one or all of the biologics they have tried. While some reactions were so severe that the person had to be taken off the biologic, some were much more moderate, such as injection-site reaction: “Skin reactions to injection occur in less than 30 percent of patients, and such patients usually complain of localized rash, burning, or itching at the site of injection” (American College of Rheumatology) For those with these lesser adverse reactions, I can offer you at least a little help. Here are a few recommendations for dealing with injection-site reactions:

• Make sure you are sticking the needle deep enough. Many people have reactions when the drug is injected right under the skin rather than deeper. So make sure the needle is on all the way before injecting the medication.
• Get yourself some hydrocortisone cream. Put in on the injection site directly after taking the shot or later on if a rash pops up. It is amazing. I use it all the time to deal with injection rashes.
•  Put a cold compress on the site. It can help reduce inflammation and irritation.

Many people have even more sever reactions, though, that can be treated with any of the above. For those people, see your doctor immediately. About.com talks about several of the side effects you may have when taking a biologic:

“Two major concerns with these drugs include the risk of serious infection or Lymphoma. Rheumatoid arthritis patients have an increased risk of developing these two problems compared to the general population. In fact, patients who have the most severe cases of RA are more likely to develop lymphoma than those with milder disease, so it will be of interest to see over time whether treatment with these medications to control disease activity may actually decrease the incidence of this problem. There is evidence that the drugs increase the risk of developing unusual infections like tuberculosis (it is recommended that all patients be screened with a skin test to check for prior exposure to TB before beginning therapy with a TNF blocker). Other serious infections have also been reported since the drug has been on the market.” 

 So, while some people may not be able to use biologics, it is a great option for those who can. Talk to your rheumatologist about them. Try one out and see if it works for you. 

Until next time,

S.P.