My RD emailed this to me | Arthritis Information

This is the link, but i pasted the text of the article here too.

http://www.acponline.org/clinical_information/journals_publications/acp_internist/weekly/2008/8/5/index.html#guidelines< ="application/x-shockwave-flash" ="sIFR-flash" ="http://static.acponline.org.s3.amazonaws.com/swf/goudy_bold.swf" quality="best" flashvars="=Highlights&antialias=&width=435&height=20&fitexactly=false&tunewidth=0&tuneheight=0&offsetleft=&offsettop=&thickness=&sharpness=&kerning=&gridfit=pixel&zoomsup=false&flashs=&opacity=100&blendmode=&size=20&zoom=100&=.sIFR-root%257Bcolor%253A%252300675a%253B%257D&able=true&fix=false&prwrap=false&forcesingleline=false&=&target=&s=false&cursor=default&version=340" wmode="" ="#FFFFFF" name="sIFR_callback_12" id="sIFR_callback_12" allowaccess="always" sifr="true" height="28" width="100%">

Highlights

Updated RA treatment guidelines include use of DMARDs

The American College of Rheumatology has issued updated evidence-based guidelines on the treatment of rheumatoid arthritis, including its first recommendations on the use of biologic disease-modifying antirheumatic drugs (DMARDs).

Highlights of the recommendations include:

Leflunomide or methotrexate monotherapy for all RA patients regardless of disease duration or activity;
Hydroxychloroquine or minocycline monotherapy for patients with low disease activity or duration less than 24 months;
Sulfasalazine monotherapy for patients without poor prognostic features;
Dual-DMARD combination of methotrexate plus hydroxychloroquine for patients with moderate to high disease activity regardless of disease duration or prognostic features;
Triple-DMARD therapy of sulfasalazine plus hydroxychloroquine plus methotrexate for all patients with poor prognostic features and moderate to high levels of activity, regardless of disease duration;
Anti-tumor necrosis factor agents with methotrexate in early RA for patients who had never received DMARDs and have high disease activity;
Anti-tumor necrosis factor agents in intermediate- and longer-duration RA for patients with moderate disease activity and poor prognostic features or patients with high disease activity, who had an inadequate response to prior methotrexate monotherapy;
Abatacept for patients with at least moderate disease activity and poor prognostic features who did not respond to methotrexate combined with DMARDs;
Rituximab for patients with high disease activity and poor prognostic features who did not respond to methotrexate combined with DMARDs;
Biologic therapy combinations are not recommended due to potential adverse events.

The recommendations I'm assuming he's trying to talk you out of AP. If that's what you're saying he's doing, send him this link back.

http://www.rheumatology.org/public/factsheets/index.asp or http://www.rheumatology.org/public/factsheets/minocycline.asp?aud=pat

Pip

No, he's on board with the AP, and he wanted me to see the bullet point about AP being endorsed by the Officials. OMG - I never noticed that every time Lev posted this as being 'ARC doesn't recommend AP anymore'.

THANKS!

Pip

I think the AP thing was that minocycline is being recommended only in very specific early mild to moderate disease..and that it is not being recommended in combo threapy or any other escalation of treatment. THis goes back to the funding of research thing. Minocin manufacturer can't fund research on severe RA and Minocin to show it works. Shannon Brownlee in Why TOo Much Medicine is Making us Sicker and Poorer talks alot about the funding of research.

Jan

Smacks Pip! on the side of her head

I like the 2-year designation. Actually, I just like seeing that the rheumatologists are trying to get their act together and get on the same page.

[QUOTE=Jan Lucinda]THis goes back to the funding of research thing. Minocin manufacturer can't fund research on severe RA and Minocin to show it works. Shannon Brownlee in Why TOo Much Medicine is Making us Sicker and Poorer talks alot about the funding of research.

Jan

[/QUOTE]

why can't Triax get research funding?

I don't think it has the billions of the biggies - Lilly, Phizer.

Jan

OK.. I thought that I read here that those trials that are run by the pharma companies are jaded anyway.

so... you'd not want them to run trials and such .. yes?

I'm trying to get "it"

i read so much on here.. trying to make sense of what is good.. what is not.. what is working.. what is an option for me.. what will never benefit my disease... jSNM... why would "others" try to cover up?

not everything works for every body..... I would never be a candidate for AP... I've had RA all my life... designated mod to severe and long term....

but I would want someone who it could work for to know about it and try it?

This is a great article -- very readable. Thanks for sharing. I am going to make my husband read it this weekend. He's a physician, and he's very nervous about my going off the plaquenil, and just using the minocin -- even though I am down to 1 200mg plaq/day now (not even a therapuetic dose) -- and I am doing very well. I think I will go to every other day in September -- and then talk to my rheum at my November appt.

This article makes it clear that for early, mild RA minocycline is successful.

Bonnie

You people are outrageous. What the ACR states is that for the mildest forms of MILD RHEUMATOID ARTHRITIS minocin can be used generally along with another dmard. Hello? What's wrong with you people? This is from the ACR link that Pip posted and if I'm not mistaken this was posted by the ACR in the late 1990s:

Description

Minocycline (Minocin) is a member of the tetracycline group of antibiotics. Although rheumatoid arthritis is not an infection, minocycline may improve the signs and symptoms of this disease. There is evidence minocycline may slow the progression of joint damage in arthritis and prevent disability like other drugs in the class known as DMARDs (disease-modifying antirheumatic drugs).

Uses

Minocycline is prescribed for patients with symptoms of mild rheumatoid arthritis, sometimes in combination with other medications to treat patients with persistent symptoms of this form of arthritis.

What they mean by this form of arthritis is mild arthritis. And now they have even toned it down to accepting minocin for only the most minor cases of MINOR RHEUMATOID ARTHRITIS. This certainly is not a much of an endorsement for minocin unless you have on your real real dark roadback sunglasses. Yous are totally outrageous. Conspiracy indeed. If we all had the palindromic form of arthritis like you have Pip and not the joint and bone destoying rheumatoid arthritis like most of us have, sure we could play with minocin or we could just take some advil whenever the palindromic flares cause pain every month or two and last for hours or days. Herxing indeed.

LEV

Let's just pretend that because the practice of rheumatology has advanced so far in the modern age, that rheumatologists are catching RA sooner, in a mild form, before it becomes severe. If minocin wasn't on that list, then it could be argued you shouldn't be on it. If you are new and have beginning RA, I would at least want to start with the least harmful drug and work up if it didn't work. That's what regular blood testing is for. I am starting to get the impression that there is a small group of RAers in here that want us to stay sick.

he American College of Rheumatology has issued updated evidence-based guidelines on the treatment of rheumatoid arthritis, including its first recommendations on the use of biologic disease-modifying antirheumatic drugs (DMARDs).

Highlights of the recommendations include:

Leflunomide or methotrexate monotherapy for all RA patients regardless of disease duration or activity;

Hydroxychloroquine or minocycline monotherapy for patients with low disease activity or duration less than 24 months;

Note that it does say "OR" and "MONOtherapy".

MY RD is a great guy at a top 5 University Hospital. He does not recommend Mino for everyone but felt is was an appropriate first drug for me. I have early (diagnosed with MRI) RA and I am against going on poisonous drugs unless I must - unless the more benign drugs do not work.

Let's not be so judgemental. Live and let live. You know who I'm talking to.I find it very interesting that mino is listed right along with Plaq. as a first defense drug. Now I'm wondering why my RD didn't offer that first with the MTX instead of Plaq? I know Plaq. and MTX are a commonly accepted drug combo, but doesn't it make sense to try the least "invasive" drugs first, especially for an undifferentiated autoimmune disease like mine? My RD has some explaining to do.

I finally figured out what this latest "guidelines" by the head rheumies bothers me - what is the definition of "mild, moderate or severe". You can barely find the word mild in any information about RA - its usually moderate or severe.

So is your RF factor being being between ___ and ___ makes you: mild, moderate or severe

What about sero-positive vs. sero-negative?

Ad nauseum

These guidelines are starting to look like something an amateur would produce.

Could we all just hold hands, sing one round of Kumbaya, and all go home perfectly healthy in body and mind? Ah! Wonderful! I am late onset, seronegative RA with major bone erosion in both radiocarpal joints. If I ever can have the pain under control, I will again go back to being the gym-jock I was two years ago. I had to do my own research and ask my RA for minocycline as well as suggest other DMARD combinations. To date none have worked as yet! I did just start the Humira pen. But I am thinking of changing doctors. I am also working toward healthier eating such as less junk bread products. Currently I am on MTX, Prednisone, Folic Acid, Minocycline,Leflunomide, tramdol, and Humira for RA.
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