RA Debate - Biologicals | Arthritis Information

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Should biologicals be used for the early stages of RA to prevent it from becoming aggressive? joonie2008-03-02 21:42:22

No.

Hugs,
 
Pip
Well, it's probably wise to use all the other DMARD'S first as it is possible that they or a combo of them will control many people's RA. Taking a few pills is a lot less traumatic than sticking yourself with a needle or having an infusion. I know someone who has had RA for 26 years and is a combo of Plaq, MTX and Celebrex is controlling it.

Why go to the biologics if you don't have too???

I know the others are less aggressive and the process of trying them takes time but I do think it's worth it.

Anyway, that is my opinion on the subject...from someone who has done them all except Orencia.
Cordelia2008-03-02 21:57:11As someone who is recently dx'd, I think that bDMARDS should always be a last resort because of their side effects. If you can take 400mg Plaquenil everyday for the rest of your life and you can control your RA, why take a harsher med>? bDMARDS are extremely expensive and there is a reason why they try so many early meds first before the move - if they work, they work, and if they don't, they know that they have at least tried. 37% of early cases will go into drug-induced remission with MTX, SSZ, and HCQ within the first two years, it is worth a shot before going onto 00/month (sometimes a week) medication.

They have found that liver transplants can change a person's immune system. While that is wonderful news for MS, and other fatal disorders, perhaps maybe, in the next 50 years or so, it could become a last-resort treatment for RA, too.
Biologics should probably not be used until it's apparent that less drastic measures aren't working. In my case, early use of Plaquenil put me into a 10 year remission. When Plaquenil quit working (which happened quite drastically), my doctor put me on MTX. My big mistake was not going to a biologic (I'm a total chicken when it comes to needles) as soon as it was obvious that MTX wasn't doing the job. I put myself through two years of hell before I finally couldn't take it any more and started using a biologic. The effects were dramatic, and I feel like I have my life back now. I just wish I hadn't waited so long ... probably 90% of my joint damage happened during the two years I dilly dallied around with MTX alone. I still use it, but in a much smaller dose that seems to work well with my biologic.
treefrog0012008-03-03 06:15:10I think it all depends on how severe the arthritis is, but my gut says reserve those for the last resort. Especially because of all the BAD side effects that are possible.   As most of you know already----I developed an irregular heartbeat from only 3 enbrel shots---so I might not be the best advice-giver on this one. Biologics scare me. Even the arava I'm on scares me!I think unless significant disease progress is evident, less severe therapies should be used first.  However, I am concerned by the long waiting times to see if a particular treatment works before beginning something else, but I don't know that there's much to be done about that.As I understand it.  Eventually everything stops working, so there's no point in jumping over everything to get to the heavies..... and then work backwards.  
Though, I wish I'd gone on Enbrel (no side effects whatsoever) to start with rather than MTX, and could have avoided feeling like SH** for months until I could cope with it.
anna
What if the "idea" behind jumping from MTX (first med tried) then to a Biological (2nd med)... was to stay ahead of the disease?
 
You know how so many of us wait and wait and wait to seek treatment, or some people the "safer" meds do not work for them and their RD works their way up to the Biologicals, and by that time RA had already ravaged their joints.
 
I wonder if they can come up with something that is some where in between DMARDs & Biologicals, but still give almost the same effect of biologicals. You know like a new 3rd step.
 
Kinda like how they mix pain meds together... like Combunox - which is Oxycodone and Ibuprofen together.
 
Joonie-my rhuemy is all for the biological at the first sign of damage.  He says if you already see erosion on the x-ray you are already on that path, and you need to hit it head on.
 
We have this possibility in my wrist even though my first flare was in October!  I'm terrified of all side effects, but my gut says you have to try.
 
By the way- to that end I attempted an MRI on my wrist this morning to clarify what was on the x-ray, but no go.  My torn rotator cuff could not get in position.  El sucko!
 
Hope your rhuemy gets you fixed up soon.

Maybe an ultrasound?

May be unpopular to say, but I do think early, aggressive treatment is best for me.   I don't want to have any damage, so decided to trust my doctor and added Enbrel when RA was still active after 4 months on mtx.  

I agree with you, Innerglow, about the each medication taking so long to work and what an incredibly frustrating process that is.

Having done three years of that and still not stabilised on a medication yet, I so understand the annoyance of that process. I would get very angry about it and I still do...the length of time it takes for each medication to assimilate into the body and work or not work. It's a nightmare.

Unfortunately, it is what we have to do and I am attempting to get to a place where I accept that it is just like that and there is nothing I can do about it.

The whole thing is horrible as meanwhile, one's life can be falling apart from this disease, while the meds are deciding what they will do.

When you are bedridden and housebound while the medications are worked through, that has a really big impact on ones life.

I still however, think it's best to start at the beginning and work your way up with the medications, that way you have the best chance of managing the disease on the least harmful medication.  Oh, I might add too...I don't know about the US, Canada, UK or other countries but here in AU, you must have tried the low level DMARDS first. You can't even touch the biologics until you have been on Arava for three months and it's failed. There are quite a few criteria you have to meet before the government when even authorise biologic use.
My RD is another one  for agressive treatment immediately to slow down significantly or stop all together joint erosion. MTX + biologics.
 
He also says that there is a window of time like 3-4 months from diagnosis to do this with the ultimate results.
 
I have read recent articles on line that suggest the same.
 
However at my last visit my blood work showed I was in a medicine induced remission (MTX & Pred). He never mentioned the Humira he was pressing me to begin before. I asked him and he said lets wait until next month when you have reduced the prednisone significantly and we do more blood work.
 
My RD was pretty aggressive too.  After mtx alone didn't quite do the trick, after I guess about 6-8 weeks he added enbrel.  And as I've said so many times that people must be tired of it, the day after my first shot, I was practically back to normal.
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