Humira Bites the Dust

Well, it's official! I have failed Humira. After 3 months of treatment, I have seen a small improvement in my inflammation markers and have felt a small increase in energy, but my disease activity remains high and my pain levels are still uncontrolled. Rheumy says if it was going to help me, it would have already.

So what's next? Rheumy had two options for me: Remicade and Enbrel. At first, I pushed for Remicade because I like the idea of being able to use loading doses to build it up in my system faster. He explained that this didn't necessarily mean it would be a more aggressive form of treatment, however, and that the two were comparable in his mind. As I'm currently driving 2 hours one way to see him, he wants me to try Enbrel first in hopes that I will be able to manage this more conveniently. So I'll do what he asks and pray that Enbrel is the one for me.

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.

2nd Humira Shot

Today was my 2nd Humira shot. This time I gave it in my thigh. I haven't figured out how long to let it "warm up" for, last time I let it sit out for about 30 minutes but it was straight out of the cooler from being shipped. It didn't burn that much then. This time it had been in the refrigerator and I read something that said to let it sit out for 10-20 minutes, so I gave it 20 minutes. It wasn't enough - it burned a lot and my leg has been sore all day. Had nausea right after the shot, again. I was told that it wasn't the Humira doing that, maybe it's just giving myself a shot.

Last night I had a seizure, first one I've had in a long time. It wasn't exactly typical in that it lasted about 10 minutes, a lot longer than usual. I've had ones like this, but not often. When they last that long, I have severe disparities in spatial- and self-awareness. Last night my brain was perceiving my body as very small while my head and hands were very large. It sounds crazy and feels even crazier. I got the usual nausea and weeping. Also had the usual burning and tingling on the right side of my face, head, and neck.

Am wondering why now? Is it the RA meds? Is it stress from school again? Is it lack of sleep? All of the above probably. I hope the RA meds aren't playing a role though. If it is and it causes seizures the way hormonal birth control does, I'm in for a lot more seizures :-/

My elbow was flaring really badly again last night. Still waiting to hear from rheumy what he thinks. I know he wants the Humira to kick in so we don't have to deal with it, but in the mean time I'm in some pretty crazy pain.

Waiting for Spring

Overwhelmed

These are from previous classes, but today it feels like I'm taking them all at once!

Well here I am at 3am just wrapping up some homework. I can't seem to get in a daily routine with it. I have such trouble sleeping when I'm supposed to be asleep that I end up napping off and on during the day.

The pain in my elbow is back, and then some. So the prednisone has completely worn off. I woke up today with very tender joints. My sternum hurt to touch! That's new! My hands and upper arms and shoulders and neck and back and geez... everything is tender and swollen.

All of this is really getting to Mark. It hurts so bad just to be touched lately that I cringe when he tries to hold my hand or rub my back. So sad that when he is trying to be so loving, all I do is shy away. 

Things that should be so easy, things that should be enjoyable... are difficult and painful. I'm having so much trouble just thinking!! It's just the second week of school and I feel so overwhelmed. :(

Waiting for Spring

Elbow Flare!

Meet Dulci, one of my two whippets. She loves her cave bed and doesn't it look comfy? :) 

I can't sleep. This happened last time I started a course of steroids, too. Plus, tomorrow is my first day of physics lab and I'm nervous to be getting back into the swing of things.

Monday I had a flare in both elbows. So obviously no effect from Humira yet, not that I expected it this soon. It was the worst pain I have ever felt, worse than an obstructive kidney stone, worse than trigeminal neuralgia and seizure headaches, worse than having a neuroma injected with corticosteroids. My elbows were so hot! It felt like the synovial fluid was replaced with MOLTEN LAVA! All I could do was lay there, keeping my arms still, and just cry. I could not believe how much pain I was in. At first, it felt a little better to extend my arm, but then any movement at all hurt. Tuesday I woke up feeling a little better, but as I used my elbow more, it flared just as badly as Monday again.

Rheumy prescribed another round of prednisone. I hate taking steroids and rheumy agrees, but he's more worried about the damage being caused by these constant flares. I know I'm lucky to have a rheumy who was willing to treat me aggressively right away and when I call with flares he always calls me back personally. I have worked with doctors for almost a decade and that is something special.

RA is moving like wildfire lately with a neck flare and the migraines that caused, new joints affected, tendonitis in flaring joints, small red bumps near flaring joints, and pain in my SI joint area. My mom was diagnosed with ankylosing spondylitis along with RA. The first rheumy I saw told me that was impossible and that her doc was a quack. He had a horrible bedside manner, needless to say. I don't know whether mom really has the fusing characteristic of AS but I know she had pain in that area.

Maybe if I lay very still I will be able to finally sleep. More likely I'll be ready to sleep when I should be waking up in a few hours. *sigh*

Waiting for Spring

♫ Talking to Myself ♫

You know - people who don't think this is all in my head or that I'm trying to be lazy are all very worried about things like... getting back to my normal schedule, exercising every day, addiction to pain meds, etc. But what keeps cycling in my head is that part of me is gone. That carefree, active me - the me that never worried about how late I stayed up or how much I pushed myself or how much stress was involved in obtaining my goals, the OCD neat freak, the perfectionist, the nothing-is-ever-good-enough goal-oriented person - has faded over the last two years and I'm grieving for my loss. The more I learn, the more I realize how everything is going to change.

When my symptoms started getting worse, I was a full-time-and-a-half student with dreams of a PhD and a career in environmental biotech research. In the last year, I dropped 3 classes, failed one, and ended up withdrawing from my whole spring semester. I also bowed out of a second internship with a huge national laboratory. I was supposed to get married this fall, but we had to break the news of postponing the wedding to our families this summer after realizing the planning is a major source of stress - and flares. I'm planning on taking some classes this fall, but very worried that I won't be able to handle it. All my plans are changing.

My energy levels are nil, I'm constantly flaring, and my symptoms are just getting worse, despite treatment. Today I gave myself my first shot of Humira. I'm excited to be starting biologic therapy and really hoping it helps soon!! I'm also taking 25mg of methotrexate per week and prednisone tapers as needed. I haven't seen results yet, but I'm trying to be optimistic. 

I have a long road ahead of me and I know I need the love and support of RA friends. I'm part of a wonderful support group that has helped me step outside my cave of anger and depression. I hope I can meet more friends through this blog and maybe someone will be helped by hearing my story. 

Waiting for Spring