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Rheumatoid arthritis can be devastating and unpredictable. It attacks joints and can leave people twisted, crippled and in pain.
Ever since the 1950s doctors have been looking for drugs to ease pain and undo damage. When cortisone-type drugs were first introduced, they were perceived as wonder drugs. Patients felt immense improvement after starting a course of therapy with prednisolone, prednisone or dexamethasone. It wasn't until years later that consequences such as weight gain, cataracts, glaucoma, hypertension, muscle wasting, ulcers or diabetes were detected. It became clear that these "miracle" drugs came at a high price. One other long-term outcome of high-dose prolonged therapy with corticosteroids is osteoporosis. As one noted rheumatologist put it, these drugs "melt bone."
When so-called non-steroidal anti-inflammatory drugs were introduced, they were enthusiastically received. The belief was since they were "non-steroidal" they would not have serious side effects (like cortisone). Drugs like diclofenac (Voltaren), etodolac (Lodine), flurbiprofen (Ansaid), ibuprofen (Motrin), indomethacin (Indocin), ketoprofen (Orudis), nabumetone (Relafen), naproxen (Naprosyn), piroxicam (Feldene) and sulindac (Clinoril) helped ease pain, but not surprisingly they came with their own set of drawbacks. Stomach ulcers, hypertension, kidney problems, irregular heart rhythms and perhaps even heart attacks and strokes may result.
When the new "biologic" medications were introduced in the late 1990s, investigators hoped that these TNF blockers would fundamentally alter the course of rheumatoid arthritis. The new "miracle" drugs included adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi) and infliximab (Remicade). Because they calm an overactive immune system they were expected to dampen inflammation and even reverse the disease process.
Why are we not surprised that it took years to learn that there were unexpected complications? The FDA has warned that these drugs can increase the risk of certain cancers (lymphoma and leukemia). People who never had psoriasis may develop this skin problem when they stop the medicine. Because these drugs suppress the immune system, both bacterial and fungal infections may become life threatening. Liver damage is another rare but very serious reaction.
Now the FDA has approved another brand new medicine for rheumatoid arthritis. Like so many of its predecessors it is being heralded as a potential "blockbuster" against a very serious disease. But patients should be aware that Actemra (tocilizumab) may also have a dark side. In Japan, where it has already been on the market for years, this immune system modulator has been linked to serious infections and deaths. The drug can cause life-threatening allergic reactions (anaphylaxis), gastrointestinal perforations, headache, hypertension, elevated liver enzymes or cholesterol. Like other immune-suppressing drugs, there is concern that Actemra may increase the risk of cancer.
Rheumatoid arthritis patients may be glad to have another option, since the current treatments leave much to be desired. Patients should be aware, however, that most arthritis drugs are double-edged swords and can do a lot of damage as well as good.
Was this information helpful? Average rating: 4.9/5 (44 votes)
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So what is the alternative...can you crepe hangers tell us? Sit in a wheel chair and become horribly crippled?
I suffered an ulcer in 1996 after taking Naperson for sore knees; and was fortunate not to lose part of my stomach, I later learned.
A rheumatologist I saw later prescribed Osteo-Bi-Flex and it has helped so much.
The ulcer incident has taught me to be very careful about the drugs I take.
Elaine
EB,
No cliff hanger, nothing new either. Drugs are bad; each has it's set of positive effects and negative effects. It's the job of your doctor and pharmacist to make you aware and consider the risks and benefits of the medications used to treat disease. The more harmful the disease the more willing we are to tolerate side-effects.
When medications are taken properly we can maximize benefits and limit side-effects.
Sorry, there are no miracle drugs or cures.
So with YOUR doctor/pharmacist/nurse/health care provider learn about YOUR disease and YOUR medication and then you can take control of YOUR life.
I became aware of the potential problems of NSAIDs when my prescribed Motrin (for osteoarthritis) caused stomach ulcers and internal bleeding that caused me to pass out while driving on the Hollywood Freeway!
I was diagnosed with ra 4 yrs. ago. I was put on bunch of drugs, among them ibuprofen and prednisone, because of this I now have stage 3 kidney disease and cataracts.
I was not told about the possible side effects then, now whenever I'm prescribed a new drug I try to find as much info as possible before I take anything that could hurt me and effect me for the rest of my life.
I am trying to get someone to look into the substandard generic Ibuprofen 800 supplied by Amneal. Most of the pharmacies in Phoenix are switching their supplier from Watson to Amneal with disastrous consequences. Doctors are switching patients to more expensive drugs. I base this information on the following:
I am a 61 year old woman who has osteoarthritis and have obtained regular relief from Ibuprofen 800. In December, I got a new prescription where the Ibuprofen was from Amneal. I did not have relief and suffered severely. When I did not heal, I contacted Walgreens and learned about the switch from Watson Pharmaceuticals to Amneal.
To make sure that it was not just a new problem with my body, I got some Ibuprofen 800 from a friend whose supply was from Watson, within three days I was back to feeling better again. I discussed it with a friend who was suffering and because of that her Doctor gave her a new more expensive Arthritis drug. I asked her to check her supply and it was from Amneal. If she had still been receiving effective Ibuprofen 800, her Doctor would not have had to change her prescription. Either Almneal's quality control has slipped or its manufacturing standards do not match the requirements for a generic.
Many of us are suffering. Please investigate. I tried to switch from Walgreens, but CVS and the SuperMarkets have all switched to Amneal. Wal-Mart is using Dr. Reddy and I will try them in the meantime. Please help us.
What are the side effects of Tramadol?
PEOPLE'S PHARMACY RESPONSE: DIZZINESS, NAUSEA, CONSTIPATION, HEADACHE, DROWSINESS, VOMITING, ITCHING, AGITATION, WEAKNESS, SWEATING, INDIGESTION, DRY MOUTH, DIARRHEA
(EVIDENTLY SOME PEOPLE EXPERIENCE CONSTIPATION, BUT OTHERS GET DIARRHEA).
THIS LIST IS NOT COMPLETE. YOU CAN FIND A FULLER LIST AT DAILYMED.
ALD,
Tramadol works like narcotics and antidepressants. It may cause headache, constipation, dizziness, sedation, serotonin syndrome (agitation, muscle twitching, fast/hard heart beat, nausea, vomiting). Stopping abruptly may cause withdrawal. Taking too much will decrease breathing.
These side-effects are similar to other pain medications and antidepressants.
If you are taking Tramadol and other antidepressants your risk of serotonin syndrome is greater.
Thankk you for the information. I need to search more on serotonin syndrome.
I have been taking Methotrexate for about a year and started taking Simponi 8 months ago for rheumatoid arthritis. Of course I do not know what long term effects, if any, I will suffer in the future, but I will tell you this. 14 months ago I could not tie my shoes, button a shirt, or cut my own food. Today I can do all those things and have very little pain. I still have some trouble with a tight jar lid now and then, but I did before I had arthritis. I can assure you, I would not be alive today without these medicines.
What is serotonin syndrome?
ALD,
Serotonin syndrome is very rare. But it can be caused usually by a combination of medications that act on serotonin receptors. Medications include: antidepressants, St. John's Wort, LSD, tramadol, Zofran, Zyvox, Duragesic, Demerol and others that either increase serotonin or decrease it's removal.
When the serotonin receptor is exposed to enough serotonin then serotonin syndrome may arise. Serotonin Syndrome includes: high blood pressure, tremor (shaking), high temperature, uncontrolled movements, diarrhea.
Be cautious that using several medications that act on serotonin increase your risk of this rare, but potentially fatal drug reaction.
I requested info on cortisone shots for pain. I have been getting them for 2 years at least. I would like to find info on the side effects of cortisone somewhere. Could someone respond with their experiences. I am 83 so I guess I've was lucky to be healthy until my 80's.
CLC,
To start with, you are in your 80's and you have a positive outlook on life. As Abe Lincoln said, "Most people are just about as happy as they make up their minds to be."
If you have been using cortisone shots for 2 years without many side-effects, I'd say you probably don't have many. Knowledge in the wrong hands can be dangerous the following is a link that list many possible side-effects few if any of these are probable side-effects.
Count your blessings ask your doctor if their are safer alternatives, but if it isn't broke don't fix it.