Rheumatoid Arthritis By Accordant Health Services

Disclaimer: This is some information i took off of the CVS Specialty Site, this is NOT written in my own words. You may or not agree with everything written by Accordant Health Services but it gives a digest readers definition and for those recently diagnosed, it might help explain.

BY ACCORDANT HEALTH SERVICES

What is Rheumatoid Arthritis?

 

Arthritis means “inflammation of a joint.” The word arthritis comes from the Greek word arth (“joint”) and itis, which means “inflammation.” There are over 120 types of arthritis. Rheumatoid arthritis (RA) is one of the most common kinds – about 1.3 million people in the United States have it. Worldwide, RA affects about 20 million people. RA has been seen for centuries. Some skeletons that are thousands of years old show evidence of RA.

 

RA is an autoimmune disease. This means that the body’s defender – the immune system – doesn’t work right. A normal, healthy immune system protects you from wounds, germs, and other threats. It does this by sending out special cells to attack the problem. But if you have RA, your immune system gets confused. Instead of protecting you, it tells the special cells to attack your own joints.

 

Joints are the places in your body where two bones meet each other. RA can affect any of your joints – knees, elbows, ankles, toes, fingers, or even the joints in your neck, jaw, or the ball or your foot. The smaller joints of the hands and feet are most commonly affected. When the immune system attacks your joints, it causes the tissue around your joints to swell. Your joints feel stiff, warm, and painful. This reaction is called inflammation.

 

Inflammation targets the thin, delicate membrane that lines your joints. This membrane, called the synovium, produces a fluid that lubricates the joints. When inflammation starts, white blood cells invade and attack the synovium. This causes the synovium to thicken. The synovium pushes against protective tissue like cartilage. Cells of the synovium release proteins that destroy cartilage, bones, and other nearby tissue.

 

As RA progresses, your body’s other organs may also be affected by inflammation. Because it can affect the whole body, RA is called a systemic disease. Some of the “whole body” feelings that go with RA can include mild fever, feeling very tired, having a poor appetite, headaches, depression, and stiff muscles in the morning. Your heart, eyes, skin, and other organs can be changed by RA.

RA does not affect everyone the same way. About 2 out of 10 of people have RA that only lasts a few months or years. It goes away and does not come back. About 70% have RA with “flares” and “remission.” This means their RA gets worse (it “flares”), then it gets better for a while (a remission). This happens over and over. For about 10% of people, RA get worse over time. It lasts for many years or for the rest of their lives.

Some RA Medicines BY ACCORDANT HEALTH SERVICES

Please remember to talk to your Doctor as everyone’s body is different.

Disclaimer: This is some information i took off of the CVS Specialty Site, this is NOT written in my own words. Thanks CVS Specialty for giving some insight on the Drugs some of us may or may not have to take!

DMARDs

DMARDs (dee-mards) refer to a number of medications that actually change the course of your rheumatoid arthritis. The letters D-M-A-R-D stand for disease modifying antirheumatic drug. DMARDs may reduce or prevent joint damage, preserve function, and maintain your quality of life. All people with RA should ask their doctor about DMARD therapy.

Although DMARDs are not members of a single drug family, all work by quieting your body’s overactive immune system in some way. DMARDS are most effective when you begin using them early in your treatment. But they are slow acting. Your doctor may prescribe an additional drug — such as a corticosteroid or an NSAID (see below) – to help control your pain and inflammation while the DMARD starts to work.

All DMARDs can cause stomach side effects. Because DMARDs dampen your immune system, you should always watch for signs of infection (chills, fever, sore throat, cough, etc). Report any signs of infection to your doctor as soon as possible. And, for the same reason, always talk with your doctor before getting any vaccinations while you are taking these drugs.

Methotrexate (Rheumatrex®) is one of the most effective and commonly used DMARDs. It may be taken by mouth or by injection. Many people take methotrexate with another DMARD like leflunomide, sulfasalazine, or hyroxychloroquine. If you take methotrexate, you should talk to your doctor about the vitamin supplement folate. There may be serious side effects like diarrhea, reddening of your skin, sores in your mouth and on your lips, or stomach pain. You should always report side effects to your doctor. Other effects, like hair loss and sensitivity to sunlight, may not be serious but still cause you concern. You should not take methotrexate if you are pregnant or plan to be. You should not start taking methotrexate if you have an infection. You should see improvement in three to six weeks, but the full benefit may not be noticed for twelve weeks.

Hydroxychloroquine (Plaquenil®) is taken by mouth. It usually has few side effects. You should have an eye exam within a year of starting therapy and report any change in vision to your doctor. You might notice improvement in one to two months. It may take up to six months to feel the full effects.

Azathioprine (Imuran®) quiets your immune system by interfering with your cells’ ability to make DNA. It is taken by mouth. Azathioprine can temporarily lower the number of white blood cells in your blood. This increases your chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. Check with your doctor as soon as possible if you think you are getting an infection or if you notice any unusual bleeding or bruising. Improvement may be noticed in 6-8 weeks, but you may need up to twelve weeks to get the full benefit.

Gold compounds have been used for more than 70 years to successfully treat RA. They are used less frequently now since new medications have become available. Your doctor might prescribe gold sodium thiomalate (Myochrysine®) or aurothioglucose (Solganal®) as an injection. Auranofin (Ridaura®) may be prescribed as an oral tablet. The most common side effects include oral ulcers (like canker sores), altered taste, and skin rashes. Some patients may experience an improvement after three to six months of therapy.

Leflunomide (Arava®) may be combined with methotrexate therapy. You take it by mouth. It stops your body from producing too many of the immune cells that are attacking your joints. The most common side effect is diarrhea, which occurs in approximately 20% of patients. You should not start leflunomide if you have an infection. If you are female, you absolutely must avoid pregnancy during treatment. Men who are trying to start a family should consider stopping leflunomide. Complete benefits may not be experienced until six to twelve weeks after you start the medication.

Sulfasalazine (Azulfidine®) contains the main ingredient in aspirin (salicylate) plus a sulfa antibiotic. It is often given for mild symptoms or used in combination with other drugs. You take it by mouth, and it is usually well tolerated. The most common side effects are nausea and abdominal discomfort. Make sure you tell your doctor if you’ve ever had an unusual or allergic reaction to any other sulfa-related medicines. Expect to see improvement in one to three months.

Cyclosporine (Sandimmune®, Neoral®) is sometimes used to treat people who have severe, active RA that has not responded well to methotrexate. You take it by mouth. The most common and potentially serious side effects are high blood pressure and kidney problems. Cyclosporine may take a week or more to have any effect. You may not notice maximum benefits for three months.

Cyclophosphamide (Cytoxan®) is used to treat rheumatoid arthritis only in very unusual circumstances, such as if you have blood vessel inflammation in addition to your arthritis. It can be taken by mouth or by injection. Its serious side effects include a significant reduction in the number of white blood cells, fertility problems, and increased risk of bladder cancer.

D-penicillamine (Cuprimine®, Depen®) is effective but unpopular because scheduling doses is hard. Rare but potentially serious side effects include autoimmune disease (eg, Goodpasture’s syndrome and myasthenia gravis).

Tetracycline, or minocycline (Minocin®) is sometimes prescribed if you have mild rheumatoid arthritis. Taken by mouth, it usually causes only moderate side effects like gastrointestinal symptoms, dizziness, and skin rash. Avoid minocycline if you are pregnant or nursing or in some cases of hepatitis B and C. You may notice improvement in two to three months.

Biologics

Biologics are considered a subgroup of DMARDs. They are called biologics because they are made from human genes. Biologics are quickly becoming the newest category of successful medications for treating rheumatoid arthritis. These drugs often work when other therapies have failed. In many cases they slow the progress of joint damage.

Although biologics work in different ways, they all block the action of certain proteins that contribute to the inflammation of your joints and tissues. The downside of these drugs is that they are expensive. Biologics are infused through a vein or injected, and they can have serious side effects.

TNF Inhibitors

TNF inhibitors are antibodies that block one kind of protein called TNF-alpha. They are used to treat active disease when other DMARDs have failed. TNF inhibitors may be used in combination with other DMARDs. For example, infliximab is often used in combination with methotrexate therapy. Improvement with TNF inhibitors is usually seen within 12 weeks.

TNF inhibitors weaken the immune system. For this reason, they make people more likely to get serious infection, including tuberculosis. You should be tested for TB (and any hint of infection should be resolved) before beginning therapy with TNF inhibitors.

People who take TNF inhibitors are more prone to a type of cancer called lymphoma. But RA is also a risk factor for lymphoma, so it’s not clear how many cases are due to the therapy and how many are caused by RA itself. Those with demyelinating disease should not take TNF inhibitors.

There are a few precautions you can take while being treated with TNF inhibitors:

  • Be alert for symptoms of infection (fever, chills, sweating, swollen glands in the neck, weight loss, persistent cough, shortness of breath, tiredness).
  • Talk to your doctor about vaccination against flu and pneumonia.
  • Undergo cancer screenings appropriate for your age and gender.

Infliximab (Remicade®) is delivered through a vein. The first dose is followed by similar doses two weeks and six weeks later. Infliximab is infused every eight weeks thereafter. Common side effects include infusion reactions, headache, nausea, and upper respiratory tract infections.

Adalimumab (Humira®) is injected under the skin every other week. Patients or caregivers must be able to demonstrate to their healthcare provider that they’re able to correctly inject this medicine. The Humira® Pen is a tool that makes injection easier and ensures correct dosing. Adalimumab can cause injection-site reactions. Common side effects include injection-site pain, headache, nausea, rash, high blood pressure, stomach pain, and upper respiratory tract infection.

Etanercept (Enbrel®) is injected under the skin one to two times each week. Etanercept comes in a prefilled auto injector for ease-of-use and proper dosing. Common side effects include injection site reactions, infection, headache, rhinitis, and dizziness.

Certolizumab pegol (Cimzia®) is injected under the skin every two to four weeks. Common side effects include headache, nasopharyngitis, upper respiratory tract infections, diarrhea, and sinusitis.

Golimumab (Simponi®) is a TNF blocker used with methotrexate in adults with moderately to severely active RA. It is administered monthly by subcutaneous injection. Common adverse events include nasopharyngitis, upper respiratory tract infections, increased alanine aminotransferase, injection site reactions, and hypertension.

Your doctor might prescribe one of the biologics listed below if:

  • You have moderate-to-severe RA and
  • You did not respond to one or more of the other DMARDs, like methotrexate or a TNF inhibitor.

Like TNF inhibitors, these drugs make you more prone to infection.

Rituximab (Rituxan®) is a cancer drug. It was approved by the FDA for use in people with rheumatoid arthritis in 2006. It blocks inflammation by targeting your body’s B cells. Rituximab may provide relief from symptoms for up to six months. One course of treatment consists of two IV infusions separated by two weeks. People on rituximab therapy usually take methotrexate, too.

Common side effects include fever, chills, nausea, headache, joint pain, itching, upper respiratory tract infection, swelling, and throat irritation. Rare infusion-related reactions, skin reactions, and brain infections ? some fatal ? have been reported in people who have been treated with rituximab. Talk to your doctor to make sure you understand all the risks and benefits associated with rituximab.

Abatacept (Orencia®) 29 is a medicine that targets your body’s T cells. T cells play a role in joint inflammation and destruction. Abatacept is administered through a vein. The first dose is infused over a 30-minute period. Additional doses are needed at two weeks and four weeks and then every four weeks thereafter. Meaningful improvement takes about 16 weeks.

Common side effects include headache, upper respiratory tract infection, sore throat, and nausea. In clinical trials, more cases of lung cancer and lymphoma were reported in people taking abatacept compared with those taking a placebo. Infusion-related reactions have also been reported.

Anakinra (Kineret®) targets a specific protein called IL-1, which contributes to inflammation. Anakinra is taken daily by injection under the skin. An auto-injector system is available to help make this easier. Patients or caregivers must show an ability to properly administer this medicine. Anakinra can lead to improvement of RA within two to sixteen weeks. It should never be used with TNF inhibitors.

Taking Anakinra can make you more likely to get infections and lymphoma. Reactions at the site of injection are common. These include inflammation, pain, redness and bruising. Other common side effects include headache, nausea, diarrhea, joint pain, flu-like symptoms, and stomach pain. Taking anakinra makes you more prone to infection and lymphoma.

Combination therapy

Sometimes drugs are more effective when they can work together. For example, some people with RA respond to a combination therapy using one of the newer biologicals and a standard DMARD, such as methotrexate. Here are just a few other drug combinations that have worked:

  • For some patients resistant to DMARDs, rituximab is effective when taken with methotrexate.
  • Starting treatment with corticosteroids before you take rituximab may make the first dose more tolerable.
  • Abatacept combined with methotrexate is effective in those who do not respond to methotrexate alone or TNF inhibitors.
  • A combination of the TNF inhibitor adalimumab plus methotrexate was found to work better than either adalimumab or methotrexate alone.

Costicosteroids

Corticosteroids (kor-ti-ko-stir-oid) include some of the most effective and fastest-working drugs for treating your RA. But they also can do great harm by causing brittle bones, cataracts, and elevated blood sugar, to name a few. To minimize your side effects, your doctor may prescribe low-dose steroids for as short a period of time as possible. Usually doctors recommend combining steroids with DMARDs ? or replacing the steroids altogether.

Pain Relievers

Analgesics (a-nl-je-ziks), like acetaminophen (Tylenol®) and codeine, are used just for pain relief. They do not treat or improve your RA. Although acetaminophen is relatively safe and inexpensive, high doses can be toxic. Avoid taking over-the-counter (OTC) acetaminophen when your doctor has prescribed drugs that combine acetaminophen and opioids like Percocet® and Darvocet®.

NSAIDs

NSAIDs (en-seds) are the most commonly used drugs for treating RA. The letters N-S-A-I-D stand for nonsteroidal anti-inflammatory drug. Examples include aspirin, ibuprofen, and naproxen sodium. NSAIDs relieve pain and help reduce your joint inflammation. But they can cause serious side effects, like heart and blood vessel disease, stomach upset, and gastrointestinal bleeding.

People who take NSAIDs on a regular basis may develop stomach ulcers. Between 1-2% of regular NSAID users experience bleeding, tearing or blockage of the intestines. NSAIDs also increase the chances of having a heart attack or stroke. If you already have heart disease, you’re at higher risk

Risk Factors for Complications

Some people are at higher risk of NSAID-related problems such as heart attack, stroke, ulcers or bleeding. Factors that you should consider include:

  • Older age
  • Longer use
  • Existing heart disease
  • A history of stomach problems, ulcers or gastrointestinal bleeding
  • Use of certain other medicines, such as corticosteroids, the anticoagulant warfarin, or the osteoporosis drug, alendronate
  • Smoking
  • Consumption of excessive amounts of alcohol
  • Infection with the H. pylori bacteria

Preventing Complications

There are several ways to reduce the risk for NSAID-related problems. Your doctor and Accordant nurse can help you find a strategy that is best for you. Possible options include:

Disease-modifying anti-rheumatic drugs (DMARDs)

NSAIDs help relieve pain but they do not slow the progression of RA. DMARDs slow and sometimes stop progression of the disease. Better control of the disease process helps reduce pain. Less pain means less need for pain medicines such as NSAIDs. Talk with your doctor if you are not currently using a DMARD.

  • Alternative pain management strategies
    Ask your doctor or Accordant nurse about alternative pain management strategies that may lessen your need for NSAIDs. Many alternative therapies such as exercise, focused relaxation, visualization, and meditation have been found to be effective in helping control pain.
  • Medicines that lessen the risks associated with NSAID use
    You and your doctor may decide that an NSAID is the best method for controlling your pain. If you have risk factors for stomach-related NSAID problems, you should discuss using a medicine to lessen the negative effect of NSAIDs. Proton-pump inhibitors reduce the amount of acid produced in the stomach. This lessens the risk of ulcers. Misoprostol is another medicine that prevents NSAID-induced ulcers.
  • Ask your doctor if you should take a medicine to prevent stomach ulcers or intestinal bleeding.
    In some people, regular use of NSAIDs can irritate the stomach and cause blood loss. This can result in anemia (lower numbers of red blood cells). This condition can be detected by a blood count test. Talk with your doctor or Accordant nurse about tests to monitor for NSAID-related problems.
  • Other
    • Take your NSAID with food
    • Use the lowest dose possible
    • Take for the shortest time needed
    • Take exactly as your doctor prescribes

There are many kinds and combinations of successful drug therapies available to treat your rheumatoid arthritis. If your medications are not working, remain positive. Take an active role. Remember that your body is unique.

Above all, talk to your doctor. Explain what works and what doesn’t. Your doctor may prescribe several different drugs before finding the best treatment course for you. The sooner you and your doctor find the right drug combination, the better.

Please help with awareness…

I really hope that people will respond to what i want to do. I want to explain to the world about our disease and how we deal with it the GOOD and the BAD stuff. So you choose either email me your story with a photo if you wish or make a video and send it to me. Tell me your story so i can make one big video about how we all live. Please talk about the meds your on now or have been on, your caregivers the good and bad times with them. Everything is important do not leave out any information that will be important to this cause. Again THANK YOU!!! ❤️

Understanding Common RA Blood tests

This information i have seen many places but it was best explained on RA Warriors(a BIG thanks to Kelly) page which can be found at
http://rawarrior.com/blood-tests-for-rheumatoid-arthritis-what-is-their-role/

But here is the what i thought was important for my own blog. 🙂

1) Rheumatoid factor: the first antibody discovered to be commonly present with Rheumatoid Disease (RD), about 70% of the time. Rf is also present in many healthy people who do not develop RD. The percentage of people who show positivity for Rf increases with established disease.
2) Anti-CCP or ACPA: a more recently recognized antibody commonly present with RD, and more specific to RD (so that there are fewer “false positives”). Between 70 and 90 percent of PRD are positive for ACPA.
3) Erythrocyte sedimentation rate or ESR: a test that measures the millimeters of red blood cells that fall in a test tube in one hour. ESR can be increased in pregnancy and in other conditions, including cancer, and often correlates with inflammation. The ESR is often normal in PRD.[1,2]
4) C-reactive protein or CRP: CRP is considered an acute-phase reactant because it can rise dramatically during inflammatory activity. CRP is considered a significant factor in heart disease. Several physical conditions or activities can impact CRP including smoking, diet, and obesity. The CRP is often normal in PRD.[1-4]

Healthy snacks

Here are 20 great snacks to have in your bag/purse etc while you are out and about or even nearby your bed. I have personally found that since my diagnosis, i have had some sugar problems and if i do not have some “healthy” treats by my side/with me, i grab junk food. I am really trying to avoid a lot of junk and here are some things that i like to always have with me! ALSO please try Coconut sugar in lei of regular sugar

1. Apple slices with lemon juice..YUM

2. Carrots and avocado dip

3. Banana

4. Dried fruit (any)

5. string cheese and grapes

6. pineapple

7. celery and peanut butter

8. 1/2 cup almonds

9. Salad

10. sliced berries

11. cottage cheese

12. Oatmeal

13. Clementine cutie

14. Honey nut cheerios

15. Oat bars

16. Fruit smoothies with yogurt

17. watermelon

18. Protein bars

19. Raisins

20 Super food smoothie with greens

Rheumatoid AWARENESS DAY FEBRUARY 2 2014

PLEASE CHECK OUT THIS PAGE http://rheum4us.org/press-release-rheumatoid-arthritis-awareness-day/
A lot of great info is on this page. I personally believe knowledge is power, so please get out their and spread the word! The more people know, the more understanding, compassion and hopefully better care we will receive. My personal GOAL for February 2 2014 is to have my personal story up on Youtube, which will also appear here on my website. I want to make a difference in the world and i want to share my life struggles with no sugar coating. I personally have multiple organ RA which is different from regular RA, and i struggle to find others who understand, so i hope that by telling my story I will help others come forward and share. It is important for us to speak up about our lives. We all are different, we all experience different things, take different meds, have different pains and aches etc. We are each others support! God Bless rd-ribbon-final