Saturday, July 05, 2008
The American College of Rheumatology recently issued new guidelines for rheumatologists to use in their patient treatment decisions about the use on non-biologic and biologic disease modifying anti-rheumatic drugs (DMARDs). The recommendations and guidelines were published in the June issue of ...
hi - I'm on Enbrel (and Celebrex), took Remicade briefly. I was never put on MTX because my liver enzymes were high when diagnosed. Since my doctor went right to Remicade (I had joint damage in my wrist already, and ankle problems), I would expect that Remicade would not cause liver problems. But someone else in one of these forums had a doctor that didn't prescribe Remicade because of her liver problems. I will check the full article, but just curious if there is anything definitive about liver involvement with the TNF blockers.
I'm also interested to know if minocycline is more often prescribed for those who are sero-negative. From other reading I've done, that's the impression I got, that it may work better, though slowly, for those who have not done well on the mainstream stuff (my doctor won't even discuss antibiotic therapy, says it was proved it didn't work in the national study. Other people I've read had very different opinions, and I have personally talked with or heard from, people that are being helped by it.) Again, just curious, because I'd like to have a back-up plan in case Enbrel stops working at some point. (I am sero-positive, and anti-CCP positive, classic erosive disease, but luckily diagnosed pretty early - for once, being a worry-wart paid off! Also, the disease runs in my family, but I'm the only one of 5 daughters to have RA. Two others have polymyalgia rheumatica and are on prednisone, doing well.)
Ellen
Hi Ellen,
In my readings, I haven't seen liver toxicity as a common side effect or danger of TNF-blockers, the way it can be with drugs other drugs like methotrexate. That said, I'm not a physician, so can't begin to give medical advice. But since they are immune modulators, there might be other factors involved for a person with existing liver damage or decreased function that would cause a physician to delay or avoid their use.
I am less familiar with minocycline. I agree that it is not in the mainstream of treatment options, so there is less information available on the web that I am apt to trust. If you really are interested and your physician won't discuss it based on lack of evidence, then I would suggest talking to other rheumatologists and researching the clinical evidence as well. If you ask her to share the study she is referencing, it might be informative and would lead to other available research on the subject.
Good luck,
Christine
I haven't either, I'm just curious, as I said.
Good suggestions - however, I'm already 70 miles from my rheumatologist and hoping not to have to go further! Unless I run into problems that can't be solved at that distance...
Thanks for writing, however - the more, the merrier!
E