Thursday, September 27, 2012

RA Treatment Options

Here's what I've learned from reading, doctor visits, and talking with other RA patients. I am not a doctor, but as a biologist I have studied biochemical reactions and understand the mechanism of some of these medications and the impact they have on feedback systems in the body.

DMARDs such as methotrexate are first line of defense against RA. They are chemical in nature and usually disrupt a feedback system that generates TNF. TNF is your body's tumor necrosis factor (natural cancer killer) and can differentiate into many types of immune cells including interleukins that, among other things, regulate inflammatory reactions. DMARDs do suppress some parts of your immune system as a way to control cells that promote inflammation.

Biologic response modifiers (BRMs) such as Enbrel and Humira are very targeted approaches to treating RA. For example, Humira is a fully human antibody that disrupts action of TNF-α. Because it only targets one type of TNF cell, it has less of an impact on your immune system than DMARDs. Enbrel and Humira are injectable because antibodies can be destroyed by the acidity of your stomach. There are other BRMs that are given via IV infusion that I am not greatly familiar with. I believe they have similar mechanisms of action.

Prednisone is a steroid that combats inflammation. It treats symptoms, not the disease. It can make you feel like you're in remission, which is great but it can also have harmful long-term effects if used in high doses for a prolonged time. Steroids can affect reproductive hormone feedback systems and cortisone production. You should never stop prednisone "cold turkey." Always talk to your doctor before starting or stopping any steroid. It can be absolutely necessary to take when you have RA, although most doctors prefer to use low doses and short cycles, such as a 7-day medrol dose pack. I have been through several cycles of prednisone and, in my experience, the more cycles you go through, the less effect it has.

NSAIDs also treat inflammation, as you probably know. The problem is they can cause liver toxicity and damage stomach lining when taken for long periods of time.

Learn all you can about RA - it's not just a joint disease. It can have vascular and systemic effects. It can attack the lining of your heart and lungs and other organs. It's not a disease to be taken lightly. Do not be afraid of biologics. They are more natural to your body than many other chemical medications. Humira is made in a way similar to how human insulin is made. Above all, find a good rheumatologist and talk to him/her about all your concerns.


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