Rheumatoid is a dynamic disease that morphs....this is why a medication that helps today may not help tomorrow.
By observing a person's reaction to a drug, we can learn a lot about the rheumatoid in that person's body...Both Enbrel and Humira are TNF, tumor necrosis factor. Individuals whose rheumatoid responds well to either Enbrel or Humira are said to have TNF driven rheumatoid. Rituximab is a monoclonal antibody against the protein CD20. For those who respond favorably to Rituximab, we say their rheumatoid is CD20 driven.
Sometimes rheumatoid arthritis can be successfully treated with an NSAID...non steriodal anti inflammatory drug...such as Orudis, Feldene, Naprosin, Naproxin, Motrin, Indomethacin, Butazolidin to name just a few.
Steriods...not to be confused with anabolic steroids...prednisone, budesonide, methylprednisolone are three of many steroids. Many decades of study have taught us to use steroids judiciously because steroids cause unwanted side effects such as bone density loss. Today, steroids are prescribed using a burst approach...high dose fast start, immediate graduated decrease, off.
DMARDs & Biologics... disease modifying anti rheumatic drug...
This class of medications modify, literally change the way rheumatoid behaves... Methotrexate (now the gold standard), hydroxychloroquine, sulfasalazine, Orencia, Remicade are all typically oral.
Rituximab is delivered by infusion as are some of the others.
Enbrel in the mid nineties was the first DMARD. I still remember watching the television news that night with tears running down my face. Those of you who face rheumatoid today should never face the full fury of this disease. Nevertheless, matching a sufferer with the best medication to defeat their rheumatoid continues to take time. As the class of medication used increases, so too do the possible adverse side effects. Be patient and work with your rheumatologist, only a board certified rheumatologist, to fine tune a treatment effective against your rheumatoid.
54 years of severe juvenile rheumatoid has left my body permanently damaged and deformed because medicine did not have the wealth of knowledge it has today.
I am grateful for all of the analgesics, NSAIDs, and steroids that made it possible for DMARDs & biologics to modify even my severe juvenile rheumatoid. Today my JRA relatively quiet. And once my rheumatoid quieted down, I forgot about the really tough times it raged.
about steroids...
I am of the opinion that an endocrinologist should supervise steroid withdrawal...the symptoms we express correlate directly with symptoms of Addison's Disease which is an adrenal gland hormone insufficiency.
I am quoting from Mayo Clinic, a highly esteemed institution in the USA:
quote
Extreme fatigue
Weight loss and decreased appetite
Darkening of your skin (hyperpigmentation)
Low blood pressure, even fainting
Salt craving
Low blood sugar (hypoglycemia)
Nausea, diarrhea or vomiting
Abdominal pain
Muscle or joint pains
Irritability
Depression
Body hair loss or sexual dysfunction in women
unquote
The further progression of Addison's leads to:
quote
Pain in your lower back, abdomen or legs
Severe vomiting and diarrhea, leading to dehydration
Low blood pressure
Loss of consciousness
High potassium (hyperkalemia) and low sodium (hyponatremia)
unquote
Mayo clinic advises we need to consult our physician when:
quote
Darkening areas of skin (hyperpigmentation)
Severe fatigue
Unintentional weight loss
Gastrointestinal problems, such as nausea, vomiting and abdominal pain
Lightheadedness or fainting
Salt cravings
Muscle or joint pains
unquote
Sounds like they were listing the symptoms of steroid withdrawal, doesn't it...
I have a pill spiltter that opens up on a hinge to expose a V shaped tray with a catch basin. You set the pill within the V, tilt the splitter so that it snuggles the pill forward deep with the V and close the lid. The sharp razor within the lid easily slices even tiny presnisone in half.
I now use the burst method when steroids are necessary...high fast on, immediate decrease, off
example
30 mg day 1
25 mg day 2
20 mg day 3
15 mg day 4
10 mg day 5
5 mg day 6