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Posts Tagged ‘autoimmune’

Given the fact that there are a slew of RA medications laying on the failure heap, I’m willing to move outside the box and so is my doctor. The latest drug to be tried will be secukinumab – brand name Cosentyx by Norvartis. This biologic is currently approved by the United States Food and Drug Administration (FDA) for the autoimmune diseases psoriasis, psoriatic arthritis (PSA), and ankylosing spondylitis (AS). Cosentyx is an interleukin 17 (IL-17) inhibitor. IL-17 is a cytokine produced by T cell lymphocytes and is connected with autoimmune inflammatory responses. I reported on clinical trials with secukinumab for RA back in 2012. In a recently reported clinical trial being conducted for RA, patients demonstrated improvement over a one year treatment period. Safety and side effect profiles match other biologics with increased risk of infections, allergic reactions, changes in liver and blood tests, and cases of inflammatory bowel disease.

My official diagnosis has been seropositive rheumatoid arthritis due to positive rheumatoid factor (RF) tests, classic RA symptoms like symmetrical bilateral presentation, and bone erosions. But I’ve also shown symptoms more associated with AS like tendon insertion tearing, large joint involvement, and uveitis but without a positive genetic marker for AS (HLA-B27). In addition, my grandmother dealt with psoriasis and her brother had a debilitating case of ankylosing spondylitis. My insurance approved this drug for my use and I will begin the weekly loading dose self-injections as soon as they are shipped. We’ll see how I respond to this newest option.

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Since being diagnosed with RA in 2009, it’s been an interesting process trying to find the right treatment combination. To date, seven biologics and four disease-modifying (DMARDs) medicines in various combinations and dosages have been tried. The DMARDS used in the past include the following:

Sulfasalazine – This was the first DMARD tried after diagnosis. An allergic reaction resulted in severe hives and cessation of this drug.
Methotrexate – Oral pills were used. Unrelenting and unbearable gastrointestinal issues precipitated an end to this trial.
Leflunomide (Arava) – This DMARD did not have much impact on RA symptoms.
Azathioprine (Imuran) – This DMARD did not have much impact on RA symptoms.
Methotrexate – Self-injections were used for the second trial of MTX. Injections were stopped about a year later due to evidence that they were contributing to migraines.

Rituxan (Rituximab) is the latest biologic and I’ve been on it for 1½ years. The typical suggested treatment plan is two infusions every six months but I’ve been on a schedule of two doses every four months. The last infusions were in October and November but it seems that its impact is not just not optimum. Joint pain, swelling, and fatigue are all on the increase and neck surgery six months ago coupled with an elbow surgery in the near future lend evidence that Rituxan alone is not keeping the disease in check. After a discussion with my rheumatologist this week, it was decided that adding another DMARD might help control the disease processes. There aren’t many choices left and my rheumatologist suggested trying Mycophenolate, or CellCept, in combination with the Rituxan infusions.

CellCept was originally developed to help organ transplant patients from rejecting their new organs. It works by suppressing the immune system. Now it’s commonly used to treat lupus but is also used for other autoimmune diseases including rheumatoid arthritis. As with many DMARDs, common side effects involve the gastrointestinal system. Blood counts can be impacted so regular blood tests are conducted. [1] There aren’t many published studies on CellCept although it’s been proposed as an alternate DMARD for those with refractory disease not responding to other treatments. [2]

A new treatment experiment begins. Hopefully it will bring some much needed relief.

[1] http://www.rheumatology.org/Practice/Clinical/Patients/Medications/Mycophenolate_Mofetil_(CellCept)_and_Mycophenolate_Sodium_(Myfortic)/

[2] http://www.smw.ch/docs/pdfcontent/smw-12441.pdf

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Rheumatoid arthritis is one of many autoimmune diseases (AD). In a normal immune response, white blood cells identify foreign invaders like bacteria and viruses. They produce antibodies against these invaders so other cells can destroy them. In an autoimmune response, your white blood cells have difficulty distinguishing between foreign invaders and your own healthy cells – in essence, your body attacks itself.1

It is estimated that upwards of 22 million Americans suffer with an autoimmune disease and more than 80 ADs have been identified.2 Some of the most common autoimmune diseases include rheumatoid arthritis, type I diabetes, multiple sclerosis, systemic lupus erythematosus, inflammatory bowel diseases, and psoriasis.3 The financial impact of these diseases is in the billions. Autoimmunity tends to more common in women and the ratio of women to men with RA is about 2.5 to 1.4 It is common for people to suffer with multiple autoimmune diseases.

Given the dramatic impact of autoimmune diseases on society and the interrelatedness of autoimmune diseases,5 it is important that awareness efforts be pursued. The American Autoimmune and Related Diseases Association, or AARDA, is the only non-profit organization devoted solely to raising awareness of autoimmune diseases.

Read the rest at http://rheumatoidarthritis.net/living/american-autoimmune-related-diseases-association-aarda/

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The Ice Bucket Challenge for ALS is all the rage right now. Hardly a day goes by that I don’t see a post on my personal Facebook page with someone pouring ice over his or her head and daring someone else to do it. It seems that every celebrity is getting on board ranging from Bill Gates to Lady Gaga. To date, over $22 million has been raised by this strategy.[1] This got me thinking about why RA and related autoimmune diseases can’t get this sort of public attention.

Amyotrophic lateral sclerosis (ALS) is also known as Lou Gehrig’s Disease after the famous baseball player. According to the ALS Association, 5,600 people are diagnosed with ALS each year in the United States and it is estimated that 30,000 some people currently live with the disease.[2] It is true that half of all people diagnosed with ALS will die within a few years and it is a most devastating disease.

However, the impact of RA on Americans is vast compared to many other diseases. Over 1.5 million Americans suffer from rheumatoid arthritis and upwards of 23 million suffer from an autoimmune disease.[3] Arthritis is the leading cause of disability and work limitations in the United States. The financial impact on the workplace and personal lives of those affected is close to 100 billion dollars annually. There are over 10,000 arthritis related deaths every year. [4] The direct healthcare costs of autoimmune diseases are estimated at $100 billion annually compared to $57 billion annual for cancer.[5] Autoimmune diseases receive much less research funding annually than cancer – about $800 million dollars in research funding every year compared to all cancers funding at $7 billion.[6]

There are many diseases worthy of public attention and research funding. And ALS is certainly one of those. But I am frustrated by the lack of public attention and funding for autoimmune diseases in general and RA specifically. Can’t someone come up with a promotion for RA that will grab the public’s attention?

[1] http://www.alsa.org/news/media/press-releases/ice-bucket-challenge-081914.html

[2] http://www.alsa.org/about-als/who-gets-als.html

[3] http://www.aarda.org/autoimmune-information/autoimmune-statistics/

[4] http://www.cdc.gov/arthritis/data_statistics/arthritis_related_stats.htm

[5] http://www.aarda.org/autoimmune-information/autoimmune-statistics/

[6] https://livingwithra.wordpress.com/2013/01/31/research-funding-priorities-for-rheumatoid-arthritis/

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I’m the only male Patient Advocate and Moderator on www.rheumatoidarthritis.net and the corresponding Facebook page. There is a great page on RA and Women’s Health on our website but no corresponding page for men. Of all the people who visit the Facebook page, only 15% of the people reached were men and only 9% of the people who actively engaged by liking, sharing, or commenting on posts were men. All of this is not too surprising given the fact that the ratio of women to men with RA is about 2 to 1.[1] But with approximately 1.5 million people in the United States with RA[2], that would mean that almost half a million men suffer from RA.

When it comes to autoimmune diseases like multiple sclerosis, lupus, scleroderma, rheumatoid arthritis, and Sjogren’s syndrome, women seem to bear the brunt of these diseases in terms of proportion of people impacted. Genetics, behaviors, and hormones…

…read more at http://rheumatoidarthritis.net/living/impact-ra-men/

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In an earlier post, I outlined how RA can impact much more than bones including many organs and soft tissues. One group of soft tissues that can be damaged by RA includes those involved with the musculoskeletal system. The musculoskeletal system involves a complex interaction between muscles, bones, joints, and various connective soft tissues – all which can be the target of RA.

Erosion of bone tissues in joints is on of the trademark symptoms of rheumatoid arthritis. Through complex autoimmune biochemical processes, the body’s immune system attacks it’s own tissues like it was a foreign invader. A cascade of signaling chemicals promotes the production of bone cells called osteoclasts that erode bone tissue and surrounding cartilage. This kind of gross damage…

Read more at http://rheumatoidarthritis.net/living/attack-on-connective-tissues/

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ACR name badgeWhat a first day at the American College of Rheumatology (ACR) Conference! I heard that there are over 15,000 people here and they are from all over the world. I spent the morning volunteering at the Rheumatoid Patient Foundation (RPF) booth and then attended sessions in the afternoon. I met the wonderful people from the Arthritis National Research Foundation and Arthritis Introspective. The exhibit hall was overwhelming!

If you want to receive regular updates via Twitter, I’m @livingwra.

Here’s a list of topics I plan to write about over the next few weeks as I have time to process information.

  1. Pharma companies spend lots of money at conferences (and give free lattes).
  2. Personalized medicine based on genomics and autoantibody profiles may be in the future.
  3. Biomarkers for various various signaling pathways may help select targeted kinase inhibitors.
  4. Autoimmune antibody markers other than Rheumatoid Factor (RF) and Anti-CCP are being investigated in order to better predict RA.
  5. People with positive RF and Anti-CCP tests tend to have higher levels of inflammatory cytokines.
  6. The lung is being investigated as a possible site of RA initiation.
  7. Systemic inflammation in RA contributes to depression.

More updates tomorrow and details about our paper presentation on Tuesday to follow.

ACR exhibit hall

 

 

 

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