Hands With Arthritis, MSM for joint pain

Autoimmune conditions such as rheumatoid arthritis and psoriatic arthritis can turn moving into misery. These conditions are far worse than aching joints; in some cases, they can be crippling. For certain individuals, TNF blocking drugs such as Enbrel or Humira can be lifesavers. But it is also crucial to understand their potential complications.

Is Enbrel for You?

Q. I have psoriatic arthritis, and asked my rheumatologist about Enbreladvertised on TV by the famous golfer who touts it specifically for psoriatic arthritis.  Even though the ad includes a list of scary side effects, I asked my rheumatologist about it.

She would not prescribe it for me, because I am a breast cancer survivor.  Enbrel and similar drugs  are called “biologics.” According to my rheumatologist, all of them are off limits for cancer survivors.   Obviously it has been determined that this class of drugs can cause cancer or cancer recurrence.  Why is this stuff still on the market?

A. Rheumatoid arthritis [RA] and psoriatic arthritis can be devastating. These conditions can cripple joints and cause incredible pain. They can also affect the entire body and leave the patient totally exhausted.

A Deal with the Devil?

Over the last 60 years patients with these conditions have been left with a Faustian dilemma. The drugs that have been prescribed for RA have eased symptoms, but at a steep price. During the 1950s cortisone-type drugs were considered miracles. A patient would limp into a doctor’s office on crutches and within days could be walking without pain after taking drugs like prednisone. It took years before doctors realized that corticosteroids could cause serious and long-lasting complications.

Side Effects of Oral Corticosteroids:

  • Fluid retention, edema
  • Insomnia
  • Irritability, nervousness, mood swings
  • Mania, depression, psychosis
  • Disorientation, confusion
  • Hypertension
  • Loss of potassium
  • Headache
  • Dizziness, vertigo
  • Muscle weakness
  • Blood sugar elevation (diabetes)
  • Irregular menstrual cycles
  • Swollen face
  • Hair growth (including on the face)
  • Itching, rash, hives
  • Increased susceptibility to infection
  • Weakened bones (osteopenia, osteoporosis)
  • Blood clots, venous thromboembolism
  • Pulmonary embolism
  • Tendon rupture
  • Glaucoma
  • Cataracts
  • Ulcers

Enter the TNF Blockers:

In the 1990s the biologic medications became the next miracles for rheumatoid arthritis and psoriatic arthritis. These drugs are known as TNF blockers. TNF stands for tumor necrosis factor, a natural compound made in the body. These are drugs such as adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi) and infliximab (Remicade).

These medications have a profound impact upon the immune system and are supposed to reduce or even eliminate inflammation in the joints. The result is supposed to be a slowing or a reversal of the disease process and prevention of joint deformity. Many experts see the TNF blockers as miraculous, but there can be a down side.

The FDA has issued warnings 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. One case of aseptic meningitis has been reported as a reaction to Humira (Wang et al, Journal of Investigational Allergology & Clinical Immunology, June 2017).  Liver damage is another rare but very serious reaction.

Side Effects of TNF Blockers:

  • Irritation at injection site
  • Infections leading to coughing, pneumonia, sinusitis, bronchitis
  • Digestive tract upset (diarrhea, nausea, heartburn, stomach pain)
  • Skin rash (requires immediate medical attention)
  • Hives, itching, sensitivity to sunlight
  • Headache, fatigue
  • Cancer (lymphoma, leukemia, skin or other malignancies)
  • Reactivation of Hepatitis B in patients previously treated successfully for the virus
  • Liver failure (jaundice and liver enzyme elevations)
  • Heart failure worsening (shortness of breath, low blood pressure, dizziness, chest pain)
  • Joint pain
  • Seizures
  • Visual problems, optic neuritis (requires immediate medication attention)
  • Psoriasis flares
  • Alopecia areata
  • Neuropathy, nerve pain

Readers’ Stories:

Here are some comments from visitors to this website. They have had a range of experience with these drugs.

SE was alarmed:

“ENBREL ALMOST KILLED ME.  Watch out for a fever and if you develop one, call your Doctor right away or get to the ER.

“ENBREL caused me to get a abdominal cyst that I was unaware of until it started spilling bacteria into my blood stream causing sepsis, which attacked my mitral valve in my heart, and I ended up having open heart surgery 3 months later.”  S.E.

Lorna has had both pluses and minuses with TNF blockers:

“I have had severe RA for 30 years. I am 48 and have had it since I was 18. I was on Enbrel for 8 years and it helped with pain and stiffness for a few years and then stopped working. I have now been on Humira for almost 2 years and it is only helping a little. I have also been having numbness and tingling and blurred vision and the rheumatologist can’t seem to find out what is causing this.

“I would like to know if any one else is having any of these problems while on Humira. I would also like to know if anyone else has tried the new drugs, Simponi and Cimzia. I am considering asking my doctor to try one of these new drugs.”

Joyce developed psoriasis as a side effect:

“I was diagnosed with RA 7 years ago.  After a few months, maybe a year, my rheumatologist decided I should try Humira.  My husband gave me my injections faithfully every two weeks for 3 years.  I did not stop or change medications but ended up with psoriasis anyway.  Of all places to have it, I had a severe case on the soles of my feet.

“My doctor switched me to Enbrel twice a week to fight it.  It didn’t help.  I got an infection, stopped the Enbrel, and my feet eventually quit hurting and I could walk again.  I could never see where the biologics helped me; they did not ease pain or fatigue.  If I were ever going to go through the injections again, there will have to be a written guarantee.”

Lou has mixed treatments and gotten good results:

“As I’ve posted in several forums here before, I have psioriatic arthritis. I started on methotrexate, then Enbrel, and now Humira. Even though I’ve had severe pain on and off for years, in 2007 I had severe foot pain due to arthritis. I was scheduled for surgery.

“However, several months before the surgery I read here about grape juice and Certo. I started taking it, and several weeks before the surgery, the pain was gone. I did have surgery to straighten a toe that was badly hammer bent that was rubbing and causing pain. I’ve been relatively pain-free from arthritis since, and I believe it’s the Enbrel/Humira, but also the grape juice/Certo, as when I stopped Enbrel for the surgery, I didn’t get worse.”

TNF Blockers Do Have Benefits:

As scary as the side effects of TNF blockers may seem, these drugs can make a profound difference in the progression of several hard-to-treat conditions, including rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis and plaque psoriasis. These diseases themselves cause tremendous pain, suffering and disability. When the medications work well and do not cause severe side effects they can be powerful allies, perhaps even miracles. No matter what, such drugs must be treated with great respect for their benefits as well as their harms. A recent review found infliximab to be the best first-line treatment for severe ulcerative colitis (Singh et al, Alimentary Pharmacology and Therapeutics, Dec. 4, 2017).

Share your own story below in our comments section. Have you done well on Humira, Cimzia, Enbrel, Simponi or Remicade? Have you experienced negative side effects? Let others know how you have made out.

Revised 12/7/2017

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  1. Kimber
    WV
    Reply

    I’ve had symptoms of RA most of my life, and lost my baby sister, at 17, to Lupus. I was diagnosed officially at age 37. It would be 7 years before going on Remicade. Remicade proved to be a miracle drug for me, placing me in complete remission. I had no symptoms of RA at all for 6 years, on Remicade, and no side effects. I then got sick, unrelated, and had to go off Remicade. When I resumed it, 8 months later, I had a very odd react during infusion. I “crashed”, was rushed to the ER, given Nitroglycerin, and was better in 45 minutes. Had a complete stress test, heart CT, nothing found as far as damage. Went back for an infusion, same thing happened. This time my Dr removed me from Remicade, due to unknown disorder reactions, as the reason.

    I was placed on Enbrel. While Enbrel helps, it’s no where NEAR as great as Remicade. I’ve also gotten more infections, bronchitis, RSV, and even Leukopenia, and Pancytopenia on Enbrel. My spleen is enlarged, and other issues, BUT, I chose QUALITY of life over QUANTITY when I chose to go on Biological drugs. I have a fairly normal life thanks to Enbrel. I still miss Remicade, 6 years later, but my Dr is hesitant to place me on a Biologic with a “Mab” in it, after my reaction to Remicade, Infliximab..

  2. Lee
    North Carolina
    Reply

    I have had psoriasis for most of my life. As I turned 38 I started to notice I couldn’t paddle out on my surf board without my shoulders and wrist hurting. It became so painful I just gave up the one activity I really loved. So I turned to hitting the gym and lifting weights to stay in shape but that, too, became very hard to do. Some days I could hardly walk up the stairs without pain.

    I got married when I was 40, and my poor wife slowly saw my downward fall. I no longer could get out of bed with out her help. My body, when I slept, would lock up, and it would take her pushing me and helping me getting going in the morning. I had noticed every time I stayed still for more than a few minutes the stiffness would come back, and it would hurt to start to move again.

    I than notice big red sores coming on my elbows. I had never had it this bad before. So I went to my dermatologist, and he said I have psoriatic arthritis, so he put me on methotrexate pills and folic acid. It didn’t help at all. At this point I felt like my life was being taking away from me. Everything I loved to do I no longer could do. Hiking, climbing, fishing, playing with my kids could not be done now with out a great deal of pain.

    Than my doctor put me on Enbrel, and my life changed. The sores on my elbows vanished, and my pain was gone. I had to take two shots a week for a month and then go to one shot a week. I have been on it for nine years, but now I have noticed some sores coming back, and my joints are starting to hurt more and more. I hurt my knee about seven months ago working on my roof, and it doesn’t want to heal up. It seems to be getting worse. My knee feels like it’s going to buckle with pain every time I walk on it. I can’t even climb stairs without severe pain. I have been to the doctor’s and they have check it. They all say nothing is wrong.

    So I am wondering how long I have until I am a cripple and not able to go to work or even type on my computer like I am doing now. I have gained weight, and I hate it! It would be better if I hadn’t lived to see my 50’s. At least than I would not feel so useless.

  3. Michelle
    North Carolina
    Reply

    I am 49 years old. Was diagnosed with RA a few years ago. I’ve had different issues throughout the years of having excruciating pain that lasted about a month and then would just disappear. I had an issue where I wasn’t sick but I couldnt breathe for some reason. They finally figured out I had RA at that time. I never knew that RA could affect the lungs. I was on prednisone for a few weeks, and it helped it go away.

    So, after I was finally diagnosed the RA dr started me on methotrexate pills and would up the dosage when noticing it wasn’t helping. I also took folic acid because methotrexate does make your hair start thinning. The mthx pills didn’t help, and I refused to take the injections because it makes your hair thin, and folic acid doesn’t help. I need my hair. So I agreed to do a research study on Humira injections (the making of a generic brand). Not sure whether I received the generic or the actual Humira but it did not take the inflammation out of my hands. In between my knuckles it’s very swollen, like someone blew air in them. That lasted for 6 months with no changes.

    Then my RA dr wanted me to try Embrel last year. I was scared to so I tried to cut out my breads (as much gluten as possible) and took my fish oil pills, and I was ok for a while, although my hands were still as puffy as before. So recently I’ve found out I have severe Osteoarthritis and its killing my back and right hip (my right hip has been hurting for a year, and my lower back for about 5 years). I’m taking tramadol for that and gabapentin at night. Still hurts but helps me be able to move, so I decided to go ahead and bite the bullet of side affects and start the Embrel to see how it works. I finally realized after 5 injections (5th week) every time I take the injection my hands and wrists and shoulders/arms start aching really badly after a few hours until several days later.

    It eventually eases off but then it’ll roll back around to take my next injection, and it happens every time. The pharmacist and dr recommend I take it for 3 months, and see if the side affects go away. And also, the swelling in my hands and wrists and ankles has not gone away, still puffy.

    I just took my 6th injection (6th week), and according to the drs, I have 6 more weeks to go to see if there are any changes from the aches and pains and stiffness since I started Embrel and to see if my swelling will eventually go down. I’m kind of scared to wait and keep taking the injections. What if it gets even worse? I don’t want to upset the RA dr. I really like him, but I’m also scared of these side affects. I’m over here thinking, “Dang if I do, and dang if I don’t, but I’m actually worse off than I was.

    Has anyone had these types of side affects from Embrel? It’s suppose to be helping, NOT hurting. I’m about to get 2 injections of cortisone in my back (for the severe osteoarthritis) next week, and I can’t wait to get some relief and get off these pain meds that are beginning not to help anymore. I severely dislike any meds, especially prescription pain meds. I wonder if the cortisone in my bloodstream will help any of my RA symptoms🤔. I’m desperate to feel better. I need some advice from people that know what I am going through.

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