The truth about living with Rheumatoid Arthritis

Biologicals

Rheumatoid Arthritis – Should I take my biological when I’m sick?

One of the most common questions people ask is whether or not they should take their biological when they are sick.

As you probably know, treatment for Rheumatoid Arthritis and many other Autoimmune diseases is based around suppressing a haywire immune system which, left unchecked, is mistakenly attacking healthy tissue.  By suppressing the immune system, the disease process is slowed or even halted completely.  Unfortunately suppressing your immune system comes with risks, the most common of which is making you more susceptible to every bug going around.

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Humira (adalimumab) – Medications for Rheumatoid Arthritis

humiraHumira is a biological DMARD (Disease Modifying Anti-Rheumatic Drug). Humira is an Anti-TNF (Tumour necrosis factor) and it is self injected once every fortnight.  Humira is prescribed for moderate to severe Rheumatoid Arthritis, in cases where cheaper medications (such as methotrexate, arava or sulfasalazine) have failed to provide benefit.

How does it work?

Tumour necrosis factor is a protein that promotes inflammation and is found in the synovial fluid and blood of patients suffering inflammatory arthritis.  Humira is a human antibody that blocks this protein, thereby reducing the inflammation and the signs and symptoms associated with it (swelling, pain, tenderness)

Humira Dose

Humira is available in pre-filled syringes and a pen auto injector.  The usual dose is 40mg self-injected fortnightly.

Humira Side effects

The most common side effects are injection site reactions – redness, swelling, itching and bruising.  This is usually mild, but if it lasts for more than 5 days or is severe, a doctor should be consulted.

Also common are nausea, headache, rash and abdominal pain and bloating.

Humira suppresses the immune system, so infections are common, as are minor infections becoming more serious.  Humira has also been associated with serious infections such as tuberculosis, sepsis and fungal infections. Though rare, these infections can be fatal.  Humira may also cause or worsen diseases of the nervous system, such as Multiple Sclerosis.  Humira also raises the risk of some cancers.

A full list of side effects is available here.

Monitoring

No special monitoring is necessary. Humira should be discontinued if an infection develops (e.g. fever) until all signs of infection are gone.

Contraindications

Patients much be tested for tuberculosis before starting Humira.  Humira is an immune system supressant, and patients suffering serious infections should not receive Humira.  Invasive fungal infections (such as histoplasmosis) and other opportunistic infections may be worsened by Humira and in some instances have been fatal.

Patients with pre-existing disease of hte nervous system, such as Multiple Sclerosis should not take Humira.

Advice in pregnancy/breastfeeding

Humira has not been studies in pregnancy or breast feeding women, and therefore is avoided.

Enbrel (etanercept) – Medications for Rheumatoid Arthritis

enbrelEnbrel is a biological DMARD.  Enbrel is an injectable drug that works by blocking Tumor necrosis factor alpha (TNF alpha), a cytokine implicated in inflammatory arthritis.  TNF alpha promotes inflammation in the body and its associated symptoms – pain, swelling and tenderness.

How does it work?

TNF alpha is produced by the body when there is inflammation.  Enbrel is a synthetic man-made protein that binds to the TNF-alpha, and so it acts like a sponge to remove most of it from the blood and the joints.

 Enbrel Dose

Enbrel is available in pre-filled syringes and a pen auto injector.  The usual dose if 50mg, self injected once weekly

Enbrel Side effects

The most common side effects are injection side reactions – itching, pain, redness, swelling and bruising at the site of the injection.  Headache, dizziness and nasal and throat infections can occur.

Serious side effects can occur.  Enbrel raises the risk of some cancers, especially lymphoma. , Multiple sclerosis, myelitis, optic neuritis and other diseases of the nervous system have been reported. Low blood counts have been seen with Enbrel and other TNF blockers.  Congestive heart failure is also a risk.  Lupus-like syndrome has also occurred.

The medication should always be discontinued if there are any signs of infection, including fever.

A complete list of side effects is available here

Monitoring

No special monitoring is necessary.

Contraindications

Patients must be checked for tuberculosis before treatment commences.  Enbrel is an immune system suppressant, and patients with serious infections should not receive Enbrel, and it should be discontinued if an infection develops.  Invasive fungal infections (such as histoplasmosis),  bacterial sepsis and other opportunistic infections may be worsened by Enbrel, and in some cases have been fatal.

Enbrel is not recommended for patients with pre existing disease of the nervous system, such as MS.

Advice in pregnancy/breast feeding

No studies have been conducted.  Animal studies did not reveal toxicity to the fetus, however as animal studies are not always predictive of human response, enbrel is avoided in pregnancy.