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yalinda
Veteran Member


Date Joined May 2006
Total Posts : 1179
   Posted 7/9/2006 4:08 PM (GMT -7)   
hi everyone.... i am going to the rhuemy on tuesday and with this weekend being so bad and all i wondered about these biologics you have been writing about  the embrel and humeras..... first as u may know i am on the mtx and prednisone but that works maybe real good 50% of the time and fair maybe another 30% and horrible maybe only 20 or so % of time as far as severe disabling pain..... first do these drugs workthrough the kidneys? and second am i a wimp for considering something added when i do not have daily disabling pain?  should i leave good enough alone?  just wondered ~*yalinda tongue

elcamino
Veteran Member


Date Joined Sep 2005
Total Posts : 1744
   Posted 7/10/2006 4:55 AM (GMT -7)   

Hi Yalinda,

I honestly don't know if the biologics work through the kidneys--I don't think they do, but I'm not sure.  Do I think you're a wimp for considering adding them to your cocktail because you do not have daily disabling pain?  Heck no.  Why should have any pain at all?  I don't think it's normal to have pain, and if you're getting pain 50% of the time, that's pretty routine.  In any case, you could always ask.  It's has surprised me lately how many rheumy's tend to avoid the biologics.  Is it the expense?  My rheumy has supported the biologics from day one.  It is standard to try mtx alone first, but he was even willing to skip that step.  I think most insurance companies only require you to fail one DMARD before graduating to the biologics.  I failed sulfasalazine.  It sounds like you're partially failing mtx.  Prednisone is not a drug you want to stay on forever, and most insurance companies would support that.  It's cheap, but dangerous.  Adding a biologic to the mtx could make all the difference in the world for you.

At least ask your rheumy about them.

Elcamino


Current dx: Rheumatoid Arthritis
Suspected dx: Early Lupus/MCTD
Current Meds: Enbrel, Plaquenil, Aciphex, Ultracet, Zyrtec, Allavert-D, Zantac, Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan


may561
New Member


Date Joined Jul 2006
Total Posts : 2
   Posted 7/10/2006 8:40 AM (GMT -7)   
Hi I am new here. I am on MTX and Plaquenil, Relafen. Doc wants to add Humira or Enbrel....well hubby is self employed which means we are self insured through blue cross blue shield of MI.....Self Insured can NOT get injectibles!! I only have a discounted Prescriptioin plan, no co pay plan. Doc said he is at a loss of what to do. Hubby makes too much money for drug companies to help, yet we don't 1,200-1,500 to pay for the meds.
Anyone else in my situation?? Doc is considering Antibiotics.
My right hand and wrist got really bad just the last 3 months, can't get ring off, will have to be cut off and wrist won't bend much at all!! Almost fused in place.

Sherrie

elcamino
Veteran Member


Date Joined Sep 2005
Total Posts : 1744
   Posted 7/10/2006 10:06 AM (GMT -7)   

Hmmm, I wonder why the self-insured cannot get injectables?  I believe the self-insured payer much higher premiums than the rest of us who have insurance through an employer, so it would stand to reason that it would include injectables.  That really bites...  I'm sorry, I really don't have any advice for you.  I hope it works out for you, though.

Elcamino


Current dx: Rheumatoid Arthritis
Suspected dx: Early Lupus/MCTD
Current Meds: Enbrel, Plaquenil, Aciphex, Ultracet, Zyrtec, Allavert-D, Zantac, Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan


yalinda
Veteran Member


Date Joined May 2006
Total Posts : 1179
   Posted 7/10/2006 7:31 PM (GMT -7)   
thanks for the advice.... i see the rhuemy tomorrow and i am so happy as the past three days i can hardly hold anything and walking is slow and painful.... hit by that darn truck again, it comes out of nowhere and POW!
 
i am uncertain about my insurance coverage on the meds and am not cray about shots but i hate this pain.... just typing this is painful and forget holding a utensil to eat. 
 
 i have to get some foam insulation tubing from the hardware store and cut up some pieces to put on my utensils and pens so i can hold the softer larger grip!  did that alot as an OT years ago, now i need it   ugh and my legs and ankles .... ugh...... miserable........ but i am preaching to the choir on this one i know....
 
gonna try that peppermint bath again .....
 
i hope this gets better soon i leave for salt lake thursday....... ~*yalinda sad

Oklahoma girl
New Member


Date Joined Jun 2006
Total Posts : 8
   Posted 7/11/2006 8:37 AM (GMT -7)   
hi may, I'm in kind of the same situation. My Rheumy wanted to start me on Enbrel, but then we discovered that i have an immune problem. I start where most people get to on those drugs. Any way I have to deal with other drugs. I'm on minocycline. it seemed to help at first but I can't tell any more. Penicillian always helps me, but I know I'm weird. Is there another drug that doesnt suppress the immune system????

erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 7/11/2006 12:54 PM (GMT -7)   

Dear Oklahoma Girl,

Yikes, really the only medications for autoimmune diseases act at suppressing the immune system...thus "autoimmune=too much immune". eyes What immune condition do you currently suffer that makes Enbrel or Humira a no-no in your case?

NSAIDS are pretty much the least of the immunosuppressive medications...but they really only control symptoms, they do nothing to halt the progression of the disease.

Antibiotics was once a first line treatment for RA.  So it may be that you can work with that sort of therapy.

Even with strict monitoring, would you not be able to start a biologic injection? 

Sincerely,

erin 


Active, Severe Rheumatory Arthritis. Crohns. AS. Chiari Malformation & Right Brain venous anomoly. Partial complex seizures. Emphysema. Rheumatic Lung & Heart. MVP and Tricuspid prolapse. Had Lymes disease for 10 years.
Meds: Humira 40mg Q 4 days; Pred 20mg prn; Pentasa 4G daily; Imuran 50mg; Dilaudid 4mg; Diazepam 5mg; Avinza 30mg; Reglan; Meclizine; LidoDerm; MiraLax & too many others.


yalinda
Veteran Member


Date Joined May 2006
Total Posts : 1179
   Posted 7/11/2006 2:47 PM (GMT -7)   
hey back from the rhuemy .... increased the mtx and prednisone for now? still in pain, but hopefully i will be better soon, before i leave on thursday? lata linda

elcamino
Veteran Member


Date Joined Sep 2005
Total Posts : 1744
   Posted 7/11/2006 5:27 PM (GMT -7)   

Hi Yalinda,  Did you ask your rheumy about the biologics?  I'm wondering why he would choose to up your prednisone without even trying the biologics.  I've always believed prednisone to be a last resort drug.  Of course, the biologics are expensive and are not for everyone.  On the positive side, I never felt better when I took prednisone (it was a high dose). I hope it does the same for you.

Elcamino


Current dx: Rheumatoid Arthritis
Suspected dx: UCTD/Early Lupus
Current Meds: Enbrel, Plaquenil, Aciphex, Ultracet, Zyrtec, Allavert-D, Zantac, Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan


erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 7/11/2006 8:08 PM (GMT -7)   

Hey all,

Yalinda, El & Oklahoma Girl...you all have such great input on the biologic useage.

Oklahoma Girl:  I was thinking about your case & did some looking into my texts for RA treatments.  I understand the immunodifiecency problem.  Say for instance with cancer patients, their chemo is sometimes delayed due to their white blood cell count being too low...so it's the same scenario here as well.

I've found some antirheumatics, maybe you've been on them already...but just thought I would put it out there for you & anyone else that might be looking for a "what the heck do I try next" treatment.  These have sorta a less severe action on the immune system:

  • SULFASALAZINE: (Azulfidine, Azulfidine EN-Tabs, SAS, Salazopryn)
  • Penicillamine:  (Depen, Cuprimine)
  • Doxycyline and Tetracycline
  • Cyclosporine:  (Neoral, Sandimmune, Gengraf)

What have you been on already & failed?

The best to you...take care.

erin


Active, Severe Rheumatory Arthritis. Crohns. AS. Chiari Malformation & Right Brain venous anomoly. Partial complex seizures. Emphysema. Rheumatic Lung & Heart. MVP and Tricuspid prolapse. Had Lymes disease for 10 years.
Meds: Humira 40mg Q 4 days; Pred 20mg prn; Pentasa 4G daily; Imuran 50mg; Dilaudid 4mg; Diazepam 5mg; Avinza 30mg; Reglan; Meclizine; LidoDerm; MiraLax & too many others.


erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 7/11/2006 8:22 PM (GMT -7)   
hey yalinda,
back to your inquiring about the metabolism of Enbrel & Humira whether it is passed through the kidneys and liver...pretty sure to this date that it still is unkown but it is highly studied that the drugs are mainly absorbed, metabolized and excreted within the vascular system.
:-)  see, not all bad things!  in fact...in my opinion taking DMARDS and biologics are safer in my book.  why?  they bypass the GI tract and really don't hit the kidneys and liver and intestines like oral steroids and NSAIDS.  long term dependency on prednisone leads to a lot of trouble.  they are necessary for acute periods, but in the long run...they do spell trouble in the end.
and really...why not get to the root of the problem with bios and dmards? 
it's one thing to treat just symptoms yet a whole different ballpark with trying to actually hit the disease where it hurts.
as you can see...i'm a real hopeful for the future with biologics and hopefully some sort of DNA treatments to one day...shall i say...CURE RA AND ALL AI DISEASES!! yeah
i pray it happens. :-)
ciao ciao yalinda
oh BTW...what's your dose now for MTX?

yalinda
Veteran Member


Date Joined May 2006
Total Posts : 1179
   Posted 7/12/2006 2:50 AM (GMT -7)   
hi everyone, thanks for al the input..... elcamino i was in such pain.... tears .... that when i went to the rhuemy i forgot the name of the meds! i know my brain was rubber and i didnt write it down big nono but in my defense i couldnt hold a pencil hardly and driving well i got there and back... so when i talkedto him about everything i told him i forgot the name he said that with my history of high BP i was limited to meds and he wanted to increase the mtx from 4 pills to 6 on saturdays. i think he uped the prednisome because i leave tomorrow for a week conference in salt lake and i could hardly walk or hold anything in my hands so i think that was his way of giving me a quick fix so i could go on the trip. plus i asked if i could skip the mtx this week as i didnt want to be tired on sat and sunday and he said yes! but when i come back 6 pills.....

i amnot on a high prednisone dose as i told him.... he thought i was taking 3 pills a day and i hated the weight gain and my face so i dropped it to 2 pills and well last week i felt good and all the parties i kept forgetting my evening dose so i was taking 1 pill only 5 mg and now i cant do a dang thing and it is my OWN fault! but again i was feeling good and i am in denial... or atleast was in denial that i needed all this stuff!

it is so hard for me to understand how last year this time i was running and going to the gym and living life with not one pill and now how i am crippled if i dont take this medicine? i know i am not the only person who must have trouble understanding how life changes like this so suddenly..... i do not want to live the rest of life with this dang disease! im P O'd , probably the next step after denial! why us! why us !

well enough venting i cant sleep with all the pain went to bed erly and have been up for hours ...got to go to work still do laundry when i get home and pack for the trip and leave at 5 am do not know how i will get it all done felling like crap.... gonna do a load of laundry now didnt do anything on weekend cuz i felt like *****

cant stay home from work clients have needs for their success at their jobs and i need to do that .... sry so bitter mainly mad at myself and life .... i pray too for a cure but pharmasuticals need to exploit and make money so it wont happen! think of a ll revinue lost if we cured diabetes or arthritis! aint gonna happen too many jobs depend on people like us

gosh i got to take a happy pill too! i ama grumpy negative person right now .... maybe i will treat myself to an iced cappacino on the way to work to see if i smile?

thanks so much for all the support .... i just luv all of u .... (((hugs))))) ouch not to tight hahahaha~*yalinda

elcamino
Veteran Member


Date Joined Sep 2005
Total Posts : 1744
   Posted 7/12/2006 6:23 AM (GMT -7)   

Yalinda, I hear you about the prednisone dose thang.  The week that I took it, I started at 80 mg, and then tapered down to 10mg.  By the time I got to 20mg/day, I was dying.  That's why when I hear people maintaining on 2mg-5mg/day I'm amazed that the prednisone is doing anything for them at all!?  I guess it's just what your body gets used to, though.  When I was put on pred., I was in a major flare and the doctor felt sorry for me; hence the high dose.  My rheumy had a fit when I told him about it (ER doctor gave me the pred.); he would never have put me on such a high dose.  In any case, I hope you have a better day today, and have fun at your conference!  Take some extra tramadol with you (or are you taking that?)!

Elcamino


Current dx: Rheumatoid Arthritis
Suspected dx: UCTD/Early Lupus
Current Meds: Enbrel, Plaquenil, Aciphex, Ultracet, Zyrtec, Allavert-D, Zantac, Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan


yalinda
Veteran Member


Date Joined May 2006
Total Posts : 1179
   Posted 7/12/2006 4:12 PM (GMT -7)   
no what is tramadol?

may561
New Member


Date Joined Jul 2006
Total Posts : 2
   Posted 7/26/2006 5:35 AM (GMT -7)   
Thanks all for your input.....Self insureds do pay more but insurance companies say we are a risk because we can cancel at any time, with companies they have a contract. Still doesn't make sense to me.
 
I have found out my friends company won't cover much of the biologics either...very strange.
 
I was on relafen, expensive, felt so so on it.  It ran out and while I was too lazy to get to the pharmacy I used Aleve...OMG I feel better on that than relafen (took 2 like doc said I could) is that strange?
 
Thanks again

erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 7/26/2006 8:57 AM (GMT -7)   
hiya may!
Aleve is a great antiinflammatory...serves the purpose as Advil does too. they go under the radar a lot. i wish you well.
yalinda: tramadol is a strong antiinflammatory, but it's through RX only.
ciao!
Active/Severe Rheumatory Arthritis. Crohns. AS. Chiari Malformation & Right Brain venous anomoly. Partial complex seizures. Emphysema. Rheumatic Lung & Heart. MVP and Tricuspid prolapse. Had Lymes disease for 10 years.
Meds: Humira 40mg Q 4 days; Prednisone 20mg; Pentasa 4G daily; Imuran 50mg; Dilaudid 4mg; Diazepam 5mg; Avinza 60mg; Reglan; Antivert 25mg tid; LidoDerm; MiraLax & too many others.

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