Enbrel to the Rescue!

So, it's been awhile...I actually felt pretty good for a couple of weeks there, and didn't feel the need to write about it. Other than the craziness of prednisone (seriously, I was like a whole different person...not cool), my body felt normal. I could walk wherever without my toes cramping up. I even went kayaking without much pain. But as the prednisone tapered off, my symptoms came back slowly. 

The past week has been rough. I started teaching my summer class, and after over a month off, it really wears me out. On top of that, the class is 30 minutes longer than I'm used to. That extra 30 minutes feels like hours.

But there is hope in sight. I was approved to start Enbrel (after making sure I didn't have TB or hepatitis...I feel like I would know either way). So today I went to the doctor with my first dose in hand. Enbrel is an injectable medication - so I have an auto injector that I have to administer once a week. I was terrified that I would do it wrong, so I wanted to have the nurse help me. The nurse at my doctor's office, Natalie, is great. She's so super nice. She did the injection for me, just so I knew what to do next time. 

But OWWWWW. It stung. In order to inject all of the medication, you have to hold the injector on your skin for 15 seconds. Longest 15 seconds ever....and to top it off, the medicine was cold (it has to remain refrigerated) so I could feel it going in under my skin. Ick.

My doctor wasn't too thrilled that I hadn't taken a dose yet, but what was I supposed to do? My last appt was 3 weeks ago, and I didn't get my test results to him until last week. By that point, it made sense that instead of taking up time that wasn't scheduled for me, I'd just wait. Whatever. He did, however, get to play with his new toy - a brand new ultrasound machine. It is really cool to me how you can see the inflammation and measure the amount of heat being produced at those site with an ultrasound. He examined my foot with it, and when he turned the heat sensors on, it lit up like a Christmas tree. No wonder it hurts so much.

Now it is a matter of time to see how the Enbrel works. I talked to a very nice nurse on the phone yesterday through my pharmacy, and she said that some people see results in 10-14 days, other within 3 months. We'll see.

The Double Edged Sword of RA

Prednisone...How I love you for making me feel 99% better. And how I hate you for making me irritable, hungry and full of unnecessary energy at weird times.

The Medicine Saga

Now, the only way to treat RA is through various medications. For those of you that don't know there are several levels of treatment that some with RA can go through.I'm am quixkly climbing the rungs...

1st level is just your basic anti-inflammatories or NSAIDS, like ibuprofen, aspirin, naproxen (aleve) and other prescription ones (I've tried two others, and have settled on one called diclofenac). These help manage inflammation - unless it's too inflamed. However, I will never forget my diclofenac. My doctor had me go off it early to get a feel for what my body was doing off meds. BAD IDEA. I couldn't move for two whole days.

2nd level is steroids. The most commonly prescribed is prednisone. I've been given this at times to try to tamper a flare.

3rd level are DMARDs, or disease modifying anti-rheumatic drugs. The first one tried is usually a drug called plaquenil, which is actually an anti-malarial. If you fail on that (nothing changes) you can move up to methotrexate. This is the most common medication prescribed to people with RA. However, it is a chemotherapy drug (the dose is much smaller) and induces miscarriages.

The final rung, if you fail with DMARDs (specifically methotrexate) are biologics. If you've ever seen the commercials for people with arthritis to live their lives better - you're listening to an ad for biologics. Humira, Enbrel, Orencia, etc. These are all drugs that must be injected directly into the body, either through IV or injections. Woooo.


So, I went to the doctor on Friday, and I've been taking the diclofenac and plaquenil for 8 weeks now. And I've only gotten worse. Last week, I was shocked at how much the heat and humidity caused my right forefinger to swell - so much that I couldn't straighten it. He took more sonograms of my hands and feet to see the inflammation and he said we need to move on. The next step would logically be methotrexate - however this is a problem. 


Getting RA at this point in my life has been an even bigger pain than it could be, all because I am planning on starting a family sooner rather than later. As I said above, methotrexate causes miscarriages, so I can't be on that drug. And it also takes 3 months for it work out of your system - so starting it now would just be a waste of time and money. However, in order to be bumped up to the biologics, you have to have tried and failed on methotrexate. I won't have any clue if methotrexate will work for me for at least a year or two. Now, getting pregnant will probably mean that symptoms will be reduced (the immune system gets repressed, and then it won't fight me anymore!) But, to not be on a stable medicine for that long is scary!


We decided to jump down to the steroids, and now I am on a course of prednisone for the next 25 days, starting high to kill the inflammation, and then tapering down until I'm taking 5mg every day. Hopefully, this will help me feel better (it already has at the high dose, I did a bunch of yard work today!) but there are so many crappy side effects, like mood swings and weight gain, that I have to deal with.


The one good thing to look forward to, which is funny in a way, is that my doctor found an area in my pinkie toe on my right foot where the bone is eroding. You're probably sitting there going "What the hell is she talking about? How is that good?" Well, if he can prove that my bones are already showing erosion, then he might be able to convince my insurance company to skip methotrexate and get me on a biologic. Just gotta wait until he gets a more powerful and sensitive ultrasound machine.


Another doctor's appt tomorrow - This time with my OB/GYN, just to keep him abreast of the whole situation....