The Young and the RA

 Having a chronic illness can change how you view things. Alternative medicines and pills that before having RA you would never consider, start sounding like good ideas. I mean, what can any of it hurt, right? So since being diagnosed with RA, I’ve started adding all sorts of pills to my daily drug intake. And thanks to my mother’s incredible researching abilities, I learn more and more about supplementary treatment options every day. (On a side note, she is so well researched when it comes to my RA that doctors have mistakenly thought she has a medical degree. Yep. That’s my mom. She’s amazing.)

But for those of you without a super mom such as mine, I thought I would throw out some of the information I’ve learned over the past few years on treatments that may help you get your RA under control. 

One supplementary treatment that has gotten some press is using fish oil pills in the treatment of RA:

“There’s strong evidence that fish oil supplements with omega-3 fatty acids can ease rheumatoid arthritis (RA) symptoms, help prevent Raynaud’s syndrome spasms and possibly relieve some lupus symptoms” (Arthritis Today). 

Borage seeds, evening primrose seed oil and flaxseed oil have also been seen to have similar effects.

Despite feelings about the benefits of pills such as fish oil, there is some disagreement on what the dosage should be. According to The Wall Street Journal, the studies done on the benefits of omega-3 have those in the study taking industrial-level doses of omega-3 — a lot more than is in the typical dose you find at the drug store. And while the benefits of adding omega-3 to one’s diet are fairly supported, there has not been enough research done on what dose is needed to be effective as a treatment for RA.

Fortunately for you, instead of downing a fist full of pills every night, you can add omega-3 to your diet in other ways:

“Regardless of the recommended dose, the need to stockpile bottles of supplements may diminish as more foods are fortified with omega-3 and as research shows ways of enhancing the benefits with other therapies” (The Wall Street Journal).

So next time you head into your supermarket to buy eggs, make sure you pick up the ones enriched with omega-3. Eat more walnuts, beans, fish, olive oil and of course take one of the pills listed above — bonus points for taking two to three of the pills a day (World’s Healthiest Foods). 

Ok, so now you know omega-3 is good for you and where to find it, you are probably looking from some more specific examples of how omega-3 might help treat your RA. Am I right?

Adding omega-3 to your diet can help not only treat your RA, but help reduce your need for other drugs such as methotrexate, which has some pretty strong side effects (See my earlier posting about methotrexate). Also the Mayo Clinic’s Web site reported:

“Multiple randomized controlled trials report improvements in morning stiffness and joint tenderness with the regular intake of fish oil supplements for up to three months […] Benefits have been reported as additive with anti-inflammatory medications such as NSAIDs (like ibuprofen or aspirin).” 

That means that you can’t just take omega-3 every once and a while. The more and longer you take it, the more it will help you.

Now, I have preached long enough about the benefits of omega-3, so I’ll give you some time to digest it all before I give you even more treatment options.

Until next time,

         S.P.

Prednisone. That little miracle drug. Most people with RA have been put on prednisone at some point during their life. When I was experiencing the symptoms of RA (before they knew what I actually had), I was put on prednisone. I remember hobbling out of the pharmacy and popping that first little white pill into my mouth, and it was like magic! I practically skipped the entire way home! I hadn’t been able to move like that for months! And that was only within a few minutes of taking the drug! Wow! I should just stay on this forever! I learned, while on prednisone, that if I took the drug around 7 a.m., even before I was officially out of bed, I would wake up without any morning stiffness. How fabulous!

Prednisone is a drug that is used:

“to treat the symptoms of low corticosteroid levels (lack of certain substances that are usually produced by the body and are needed for normal body functioning) […] Prednisone is in a class of medications called corticosteroids. It works to treat patients with low levels of corticosteroids by replacing steroids that are normally produced naturally by the body. It works to treat other conditions by reducing swelling and redness and by changing the way the immune system works” (MedlinePlus).

Because of the way the drug works, I was told it was best to take in the morning, but consult your doctor about when you should take it. When you take it can be almost as important as the dose in relieving the pain caused by RA. 

When I first started taking prednisone, I felt amazing! It was as if that tiny little white pill solved all my problems! Unfortunately, I soon experienced the nasty side effects of this so-called miracle drug. I started breaking out in acne like I was back in middle school. My face became extremely round (they call it moon face). I had irregular periods, tiredness and gained weight. According to MedlinePlus, prednisone has the following side effects if take for any extended period of time:

• “headache
• dizziness
• difficulty falling asleep or staying asleep
• inappropriate happiness
• extreme changes in mood
• changes in personality
• bulging eyes
• acne
• thin, fragile skin
• red or purple blotches or lines under the skin
• slowed healing of cuts and bruises
• increased hair growth
• changes in the way fat is spread around the body
• extreme tiredness
• weak muscles
• irregular or absent menstrual periods
• decreased sexual desire
• heartburn
• increased sweating”

Turns out, prednisone is not the miracle I was looking for. I cannot even begin to describe to you how ugly and horrible I felt when these side effect kicked in. See if you can see the difference. The acne isn’t as obvious in the pictures; I really just look red, but trust me, it’s there.

It was a terrible experience. I look back at pictures from that time, and I wonder how my boyfriend could ever have been attracted to me (I met a wonderful guy right about the same time I started taking prednisone. He was such a support while my doctors figured out what drugs to get me on. I feel so lucky to have some so amazing and understanding in my life.) Once I got officially diagnosed with RA, I was started on a number of drugs before being put on what I am on today (Humira, Imuran, methotrexate). It did however take me quite a long time to get off prednisone completely. For a while, every time the doctors tried to take me off, I would have a flare-up. I was on prednisone for close to nine months before I could get off it, and I had been on methotrexate for over eight of those months and Enbrel for about half of them. Yeah. Longest prednisone taper ever.

Now, I do still have a bottle of prednisone tucked away in my bedside table for those horrible days when I wake up with terrible joint pain (my rheumotoligist prescribed it for when I have bad days, but I have to say I only will take a 5 mg pill about once or twice a month now, and that makes me feel great!). I definitely recommend getting a prescription for the occasional flair up if you don’t already have one!

In fact, a new study just came out that found modified-release prednisone is even better than the standard, immediate-release version at reducing morning stiffness in people with RA. The study was done by German researchers at Charite University Medicine Berlin:

“After 12 weeks of treatment, patients taking the modified-release version experienced an average of 44 minutes less morning stiffness per day than at the start of the study. That was 29.2 minutes less than those who took the standard version, the team noted” (washingtonpost.com).

Just remember, prednisone is NOT A VIABLE LONG TERM TREATMENT OPTION!!!! The side effects are so not worth it!

Until next time,

S.P.

*Some of the side effects of prednisone can be serious, if you are currently on the drug and experience any of the above side effects, consult your doctor immediately!!!!!!!!!

Today New Jersey’s attorney general said she has subpoenaed biotechnology company Amgen Inc. regarding allegations that it promoted Enbrel for unapproved uses, according to an article on Reuters.com. The subpoena was served on Monday, Jan. 14 and calls for Amgen to hand over documents and information about the marketing and sale of Enbrel from July 2002 to the present by Feb. 4. 

Current regulations set forth by the U.S. Food and Drug Administration only allow drug companies to promote their products for uses that have been approved by the FDA. Enbrel was first approved to treat RA and later received approval for psoriatic arthritis and moderate to server psoriasis. New Jersey is investigating whether Amgen broke medical privacy laws in order to direct marketing. New Jersey believes that Amgen encouraged illegally accessing patient records to persuade insurance companies to pay for the drug and also supported the promotion of Enbrel for cases of psoriasis that were less severe than those it has been approved for (Reuters).  

According to Reuters, Amgen’s spokeswoman said that the company intends to cooperate.   

Hopefully this subpoena won’t affect the availability of Enbrel for RA patients, but I’ll keep my eyes and ears open for any updates. 

For those of you unfamiliar with the drug, Enbrel is part of a class called biologics:

“Biologics are genetically engineered proteins derived from human genes. They are designed to either inhibit specific components of the immune system that play a pivotal role in either fueling or suppressing inflammation (a key component in several forms of arthritis, such as rheumatoid arthritis and psoriatic arthritis)”(WebMD.com).

Biologics are different from other RA drugs because they affect a specific component of the immune system rather than the entire immune system, which means that biologics have fewer side effects. I was put on Enbrel shortly after I was diagnosed with RA, but my rheumatologist has since switched me to Humira, another biologic. Research has found that some people react better to one biologic over another. Other biologics include Kineret, Remicade, Rituxan and Orencia. Some biologics, such as Enbrel and Humira, require you to give yourself shots every one or two weeks while others, such as Remicade, are given to you intravenously every four to eight by a doctor, nurse or healthcare provider. The best results are seen when biologics are combined with methotrexate (Hospital for Special Surgery).

If you have RA and aren’t currently on a biologic, talk to your rheumatoligist. Biologics have shown great success in helping reduce the long term effects of RA. So what are you waiting for?  

Until next time,

 S.P.