I had a list of questions all ready for a recent visit to my rheumatologist. But foremost on my mind was the fact that I just haven’t been feeling all that well since starting on Humira. Granted, I only had two injections since it was first prescribed. But I was hoping for a sign of some improvement. I mentioned that I read on the prescribing information sheet (those pages long, tiny font, highly technical insert nobody reads) and it mentioned that if the patient is not taking methotrexate, then Humira can be prescribed weekly instead of every other week. My doctor looked at me and said that was true and that he would change the prescription. I’m still waiting on insurance approval before starting weekly injections.
Since my stomach can’t handle oral NSAIDs of any kind (see earlier post), I asked about using Voltaren (diclofenac sodium). This is the first NSAID topical gel approved by the FDA. I read about it on various RA blogs and Terry from the blog Dual Sports Life recommended it. My rheumatologist smiled and said that it would be a good idea to try it. But then I wondered why I had to raise the topic and he didn’t offer this as a solution after all the problems with NSAIDs over the past year? On a side note, the Voltaren does make a difference on a flaring joint and I like it!
Both of these situations made me wonder who the prescribing doctor was in my case. It raised all sorts of questions in my mind like,
- What if I didn’t read a lot about RA?
- Why do I have to bring up issues and make suggestions during doctor appointments?
- What would happen if I was not my own advocate?
- Are all rheumatologists like this?
- Should I switch doctors?
- If I switch doctors, am I perceived as being a pest?
I’ve liked my rheumatologist up to this point because he has been quite aggressive at treating RA from the very beginning. But I also know that a positive doctor-patient relationship is critical to RA treatment.
Read Full Post »
While sitting in the waiting room of the dentist today, I noticed an article written by Catherine Price in the March 2010 issue of Popular Science[i] about rebooting the immune system of people with autoimmune diseases like type I diabetes, lupus, and rheumatoid arthritis. Naturally, the title grabbed my attention. Price has type I diabetes and participated in early clinical trials (she also writes a blog). Part of the interest is also personal as someone fighting rheumatoid arthritis. I’m also interested because someone from my church is fighting a rare autoimmune disease, aplastic anemia, and the proposed treatment is to wipe out his immune system and start over…a “rebooting” of the immune system.
Some success with using antibodies to reboot the immune systems of multiple sclerosis patients has been reported.[ii] Stem cell transplants have also been used.[iii] [iv] Stem cells are harvested from a patient and are then purified. The immune system is wiped out and the stem cells injected to restart the system. There are obvious dangers in such an approach and my friend from church will need to be isolated for many weeks in order to avoid contracting an infection.
Rituximab, or Rituxan, is a biological antibody originally designed to treat lymphomas and other cancers. This antibody inhibits B-cell lymphocytes (acting on the protein CD20) and is approved to treat rheumatoid arthritis usually after a patient does not respond to the more commonly used TNF blockers like Enbrel and Humira. Rituxan provides a form of immune system rebooting and is usually one of the last RA treatments attempted.
In the Popular Science article, researchers are working with other biological antibodies focusing on CD3 proteins which are receptors on T-cell lymphocytes. As Price notes, “…anti-CD3 monoclonal antibodies might be more like guided missiles than conventional immunosuppressive drugs.” Such specificity would be better than the general suppression of the entire immune system approach of current biological and chemical RA treatments. There is only one anti CD3 antibody approved for medical use by the FDA, muromonab. It is used for organ transplant patients to help them avoid rejection. There are anti CD3 antibodies being tested for other autoimmune diseases like Crohn’s and psoriasis and there’s hope that such biological treatments may one day become available to RA.
Perhaps sometime in the future we’ll be able to hit “control-alt-delete” on our immune systems and reboot them into a fresh start. Until then, I’ll keep taking Humira injections (even though it doesn’t seem to be doing a whole lot for me yet).
Read Full Post »