How Your RA Body Feels on Biologics
Here's what to expect when you start biologics for RA — straight from people who take them and some medical experts, too.
For Eileen Davidson,33.生物制品就是生命。没有这种药物,她很难爬上一段楼梯。或者在她6岁的儿子雅各布睡觉前保持清醒。或者只是发挥作用。
Davidson recently had to stop her生物治疗对于类风湿性关节炎(RA),在小手术之前,两者之间的差异是显著的。
戴维森在她的博客慢性艾琳上分享了她的患者经历,她说:“由于疲劳和眩晕,最简单的任务很难完成。”。
在她的药物Actemra(托西利珠单抗)的帮助下,她能够“处理健康人通常认为理所当然的一些最小的事情”
但是,戴维森在不列颠哥伦比亚省温哥华(不列颠哥伦比亚州温哥华),并于2015年被诊断出患有RA(她也有骨关节炎或OA),也没有在生物学中最容易的时间。她经历过睡眠障碍,增加了抑郁症,恶心,胃疼痛。
所有生物学,是大量蛋白质抗体,其靶向导致Ra的炎症反应,并通过......
输液(四)
Injection
与大多数药物一样,生物学通常具有长期副作用的长期效果。他们也是强大的治疗师。
关键是找到正确的平衡。华盛顿关节炎和风湿病协会的风湿病学家贾斯汀·彭医学博士说:“生物药物通常比非生物药物更有效地治疗RA症状,甚至在某些情况下更安全。”。
“As with all medications, the risks and benefits should be discussed with the doctor so that the best treatment program can be developed for the individual patient.”
目标总是呢?尽可能地减少你的RA活动。And when you know how biologics might make you feel—both positively and potentially not so—you’ll be better able to navigate any pitfalls and make smart changes to get you where you need to be.
生物制品的副作用(以及你能做些什么)
副作用包括但不限于这些(按大部分最少的顺序):
Infections
注射部位刺激
head
恶心
Allergic reaction
心力衰竭(但仅限于有心脏病病史的患者)
增加患某些类型癌症的风险
是的,其中一些副作用是可怕的,包括患癌症的可能性(“尽管研究好坏参半,因果关系尚未得到证实,”彭博士说)。但他说,即使存在这些潜在风险,生物制剂也值得你考虑。
让我们更详细地走过两个最常见的副作用。
Infections, to start.
“These medicines are all working to suppress the immune system in a way that then translates into reduced inflammation and better quality of life,” says Brian Horgan, P.A.-C., a board-certified physician assistant at Tri-State Pain Institute in Erie, PA, a comprehensive pain- and arthritis-management center.
As a result, your body has fewer defenses against common viruses and bacteria. Published data suggests the risk for infection is higher in some populations than others: In ananalysis在5596名患有炎症性慢性关节炎(包括RA)或银屑病的生物制剂患者中,4.2%(或289人)的感染严重到需要住院治疗。
老年人的风险更高or those with comorbidities. The most common infections were in the upper and lower respiratory tract—so basically,感冒, sinus infections, pneumonia, and bronchitis.
戴维森感冒了,她无法在她的第一个生物学,鬣狗(阿巴木钱)上震动。虽然在第二个Orencia(AbataCept),但她开发出严重的盆腔感染。
为了降低生物学的感染风险(并且通常也是一般),你不必做得超过通常的事情。彭博士推荐:
经常洗手
Avoiding anyone sick
避免可能含有有害细菌的生或未煮熟的食物
接种疫苗(但首先咨询医生,因为生物制剂带来的免疫力较低,在开始治疗前接种某些活疫苗可能更安全)
Irritation at the injection side, next.
根据关节炎基金会,这些注射部位的反应可以是“相当常见的”,通常是在开始用生物制剂治疗时(它们对于注射的不太常见,通过IV递送)。
This happened to Cathy Kramer, 51, who lives in Naperville, IL. She now injects Enbrel (etanercept) in her thigh after she developed an itchy rash on her stomach. Amgen, the company that makes Enbrel, lists injection site reactions as a common side effect (and the Arthritis Foundation notes that side effects labeled as “common” occur in 1 in 10 who take a drug).
“A local injection-site reaction is typically associated with a tissue irritation response surrounding the area where the medication was administered,” says Horgan. “Local reactions usually resolve within a few days. This is different from an anaphylactic or systemic allergic response, which can have serious implications.”
彭博士说,在注射生物制剂之前,以下是一些减少注射部位问题(容易治疗)的技巧:
在该地区结冰
Use a topical agent, such as topical lidocaine (but be sure to discuss with your doctor first)
将可注射物加热至室温
在生物测试中你会有什么感觉?
事情是这样的:霍根说,生物制剂可以是“神奇药物”,但和其他任何药物一样,它们并不完美。所以,虽然你可能认为你所有的症状都会停止,但也可能是他们安静下来,但偶尔会出现一些症状拉焰。
对于克拉姆人,她的喇叭子在没有生物学的几天内持续数月。那些耀斑现在更容易管理。她能够在当地社区学院的支持人员全职工作,在生物学之前,她无法完成。
克莱默说:“我肯定知道我得了风湿性关节炎。它并不是神奇地消失了。”。“在大多数情况下,我偶尔会出现闪光,但通常是当我做得太多时,或者我让自己陷入压力之中,但它们很短,与我过去在使用这种生物制剂之前的情况完全不同。”
她的手指仍然僵硬,她的膝盖偶尔会膨胀,但她可以处理这些症状。
“I feel normal again. It’s just being able to live my life again,” she says.
A good response to a biologic (and the goal of treatment) is remission, Horgan says. So you could potentially expect:
减少刚度,肿胀的关节和疼痛
Improvement in range of motion and level of functioning
提高活动耐力和生活质量
血液工作中炎症标志物活性降低,X射线显示关节疾病进展稳定
“生物制剂是由患者治疗计划的许多部分组成的谜题中的一大块,”他说。
如果你的生物学不是减轻你的症状 - 或者正在增加你的副作用 - 你的医生可能会把你送到另一个。其迹象不起作用包括不良事件,即不会消退,没有症状浮雕,或者您开发自己的抗体,在停止炎症时不再有效(您的医生可以测试)。
Davidson is currently on her third biologic after experiencing intense side effects with the previous two. But the trial and error has been worth it. Prior to starting biologics, she tried 18 drugs total for RA, including methotrexate, the标准DMARD,或治疗风湿病的药物。她对此反应不好药物,体验强烈的副作用。
“我很难打扰感染,我真的很麻烦,有腹泻,”她写在她的博客上。“一些药物我只能在几周内,因为他们造成了这种严重的抑郁和情绪在我身上摆动。”
“当我准备开始生物学的时候,我害怕毒品,我避开了他们和我的风湿病学大约六个月,”她写道。
现在,她在做生物测试时感觉好多了。她会写字。她能跟上她的儿子。她还可以成为一名患者倡导者,担任关节炎协会大使和加拿大关节炎研究患者咨询委员会成员。
Finding a biologic that has little to no side effects for her has meant everything to Davidson, because in addition to having reduced pain and reduced damage to her joints and organs, in the last two years she’s been on Actemra, she feels “more in control of my disease.”
你什么时候会感觉好些?
你可能会在几周内,或在开始服用后的三个月内,从生物制剂中得到结果或反应。“虽然生物制剂的有效性各不相同,但我通常告诉他们要耐心,”霍根说。
他注意到,最好的结果通常发生在组合治疗中,例如生物药剂和甲氨蝶呤。
2004年诊断为RA的Kramer一直在嵌入式(第一次生物学),近10年,但她仍会记住她在开始药物的几周内如何改善她的症状。
“了解很多人没有良好的结果,我不希望任何人预期立即结果,”她说。“然而,我觉得我有一个乐观的观点进入它。我也意识到这个可能会结束,我会尝试另一个。ra是一个过程。“
一旦你在生物学,你可能会每三个月左右看到你的医生,让你的回复(和可能的副作用)监控。You’ll typically have blood work done at those visits, to test your levels like inflammatory markers and blood-count abnormalities, according to Dr. Peng, which can measure for the effects of long-term use of medication and infections, among other issues. These tests will help your healthcare team monitor your body’s ongoing reaction to the drug.
Be sure to call your healthcare team if you experience any side effect outside of those regular visits—even if you’re not sure your symptom is related to your medication. It’s better to be proactive when on biologics than to run the risk of your condition worsening, he says.
In Horgan’s community-based practice, he might see a patient more often than every three months if they have issues with their RA that won’t stop, like residual pain and inflammation, or musculoskeletal issues, such as tendonitis or bursitis.
Davidson had something similar happen. She tried Actemra for six months to see if it lessened her RA symptoms, but she was still experiencing pain, and was concerned it might be a flare.
So she got a second opinion and an ultrasound, which showed her that the pain was actually permanent joint damage from RA and OA—her new biologic wasn’t the issue.
她说:“知道自己走上了正确的治疗道路,控制住了炎症,我感到如释重负。”。“我对自己的疾病和局限性了解得越多,就越能看到Actemra对我的整体作用,我对现代医学的进步感激不尽。”
yumhee公园的额外报告。