Previously on Stepping Stones, we talked about one set of medicines used to help people like me battle our psoriatic arthritis. Today's focus will be on DMARDS. Yep, another acronym of a big long name. You would also guess correctly that I'll be using the abbreviated version throughout the post. DMARDS actually stands for disease-modifying antirhematic drugs. Most often these are given to people who have not responded well to NSAIDS and need more help in slowing or stopping joint and tissue damage. They can relieve severe symptoms and possibly slow the progression of PsA. DMARDS are also used in the treatments of other diseases including rheumatoid arthritis, lupus, ankylosing spondylitis and other related diseases.
Since DMARDS are considered to be a second line of defense in the treatment of PsA, they are sometimes used in combination with other types of medications. If you have been taking an NSAID for a long time and the dose in consistently being upped as I had happen in the past, then it's probable that your doctor will consider adding a DMARD to help fight the PsA and bring the doses down to a safer level. DMARDS are not something that will act quickly in releiveing your pain or stiffness. These drugs can take a period of time such as a few weeks to months to actually show results. That's another reason why they are used with other medications.
DMARDS don't act like the NSAIDS when helping to deal with PsA or alike diseases because they aren't designed to do battle with the enzymes that help create inflammation. These types of drugs actually work to modify or change the immune system's response to the increased inflammation. In same cases, the immune system is actually suppressed by the medication. That's why I can't stress the importance of being open with your doctor when going through these treatments. Something as simple as the common cold could spell big trouble for someone who has little to no immune system. I kinda feel that when you reach this level, it's not a time to play around with the medications or the doctor visits. It's your health at stake.
Now, there are some medications that fall squarely in the DMARDS category. There are also drugs that can be put in the category but also have a category all their own. Welcome to the world of Biologics. Having come into use recently (and by recently, I'm talking within the last 15 years), these drugs help to calm the immune system's signals that ultimately lead to joint damage. Because they are newer, there isn't a lot of data on the long-term use or side effects. Biologics are thought to have fewer side effects than the standard DMARDS treatments. However, they have been show to really help improve the lives of people living with an auto-immune or rheumatoid condition such as PsA or severe rheumatoid arthritis. Once again, it comes down to speaking with your doctor and weighing all your options before beginning any course of treatment.
Each of the medications carry their own side effects but I have noticed some that are common with all of them. Some of the lesser side effects include stomach upset, nasusea, diarrhea, skin rashes (not your psoriasis), temporary hair loss, and blood issues such as thinning or low white blood counts. There are some really bad ones too. I mean really scary side effects that I, myself, have experienced. You have to make sure to get your regular blood work done when on these medicines. Some of the more serious side effects include liver toxicity, liver damage, discoloration of urine/tears/sweat, problems with the pressure of your eyes, infections, and sometimes shortness of breath. Any of these symptoms should be reported right away. If you feel you're unable to wait to see your doctor, you should visit your local hospital.
Which medications fall under the DMARDS or biologic headers? I have a small list ready for you. Some you may have heard of and others may surprise you. A number of the medications were designed for use in treating other diseases such as cancer or malaria. They have been shown to help patients like us.
- Methotrexate
- Sulfasalazine
- Hydroxychloroquine
- Cyclosporine
- Enbrel
- Humira
- Orencia
- Rituxan
- Gold
I had been on Methotrexate (MTX) but unfortunately, I wasn't monitored very well. I ended up with liver damage that sent me to a new doctor and then on to a rheumatologist. I had to let my liver heal before pursuing another treatments. I'm very thankful that the liver can heal itself. Honestly, if it was another organ, I'd probably not be here. I was placed on NSAIDS for a bit and then we tried Enbrel. That became my miracle. I was able to move so well with a lot less stiffness. Too bad I went and had a blood clot in my lung. I had to stop the Enbrel and other medications because the doctors couldn't find the cause of the blood clot at the time. Through some investigating, we've discovered that I have a disease that makes the blood "sticky" so it is easier to develop clots. My rheumy and I have been talking about going back on the Enbrel. Right now, I don't know that it's feasible given my current financial situation. But I didn't have that many side effects while on the Enbrel. I had the injection site redness and some tummy upset but not much else.
Right now I'm currently taking the Salsalate (NSAID) alongside Hydroxychloroquine (Plaquenil). Since I've been on the Plaquenil for a couple of years now, I do see some relief but I've had to go through some side effects that I hadn't counted on as well. My hair has been thinning since about a month after I began the med. I still find more strands on my pillow or in my brush each day. It leaves me feeling very self-conscious because I already have the psoriasis on my scalp. If I went bald...oh geez, that would be horrible to consider. I have recently developed an intense sensitivity to sunlight. Just the other day, I stood in my doorway to talk with my neighbor for about ten minutes or so. A few hours later, I had welts on my arms and began to itch like crazy. Thank goodness for Benadryl. So now it's go nowhere near sunlight without my sunscreen. My doctor has me going for eye tests each year so that we can make sure all is well with my eyes.
What this all boils down to is pretty much what I have been saying repeatedly the last couple of posts. These medications can help you live a "normal" life. You can do so many things when you are able to find the right combination that works for YOU. Just because someone had a bad experience with a drug does not mean it will happen to you. Keeping yourself open to all remedies can help you find the right ones. Just be open and honest with yourself and your doctor. With the advancements in just the past ten years alone, I'm excited to see what happens in the next ten years. Maybe one day, we'll have a pill that takes care of it all. So hang in there. Keep a record of what you feel and talk to your doctor about everything.
Until next time,
Kay
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