The Young and the RA

I thought I would lay off the biologics for today and instead write about another class of RA drugs: Immunosuppressant.

“For treatment of very severe active rheumatoid arthritis, physicians are now prescribing third-line drugs that suppress the body’s immune system” (About.com).

This class of drugs is often included under the DMARDs category, and includes azathioprine (Imuran, which I am currently on), leflunomide (Arava), cyclophosphamide (Cytoxan) and chlorambucil (Leukeran). These medications work by taming your immune system, which of course is running wild in RA. Some of these drugs attack and eliminate cells associated with RA as well (Mayo Clinic).

 Of these drugs, azathioprine is the most commonly prescribed and has side effects similar to other RA drugs, such as stomach and intestinal distress, skin rash, mouth sores and anemia (About.com).

Leflunomide is also a fairly popular drug for RA:

“Leflunomide can improve symptoms, slow or prevent the disease from getting worse, and improve function in people with rheumatoid arthritis. It also seems to be well-tolerated, and slows disease progression as seen on X-rays.

“Leflunomide appears to be beneficial when used alone or in combination (combination therapy) with methotrexate, another DMARD” (Yahoo Health). 

The biggest problems with drugs such as these, as with most RA drugs, is how they affect our immune system and leave us vulnerable to infection — always a problem come cold season. Those sniffles, while causing others to just have to carry around a tissue for a few weeks, can leave those of us with compromised immune systems down for the count.

So make sure to get your flu shot! Not getting it would put you closer to death than you’d ever wish to be.

Until next time,

S.P. 

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. 

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!!!!!!!!!