at the Water's Edge

Living life and learning all I can along the way!

A New Shield, A Better Shield?

I had a doctor’s appointment to see my rheumatologist on Tuesday. It had been six months since I had seen him last, and I knew we were going to be up for an interesting appointment. The last time I was in was shortly before our backpacking trip to Isle Royale. I was feeling pretty well and was able to go on my week-long backpacking trip without incident (with the aid of prednisone!). In the meantime, my rheumatoid arthritis started slowly flaring in various joints – including ones that aren’t normally affected in me. While it hasn’t been terrible, it’s been noticeable; and I realize now that my “baseline” has shifted quite a bit in the past 6-9 months. Based on how I was feeling, I knew that my blood work (testing for inflammation) was going to reveal that something bad was going on (that story is forthcoming!).

Sure enough, my doctor was concerned. The blood work tested my Sed Rate (erythrocyte sedimentation rate / ESR), which can reflect the level of inflammation in my body. My doctor said that my Sed Rate from my latest lab results was 40 and that he considers anything over 25 to be high. As a comparison, he referenced some lab work from 2010, when I was feeling very well, where my Sed Rate was 14. Yep. The blood work revealed how I’ve been feeling all right! Based on that, along with my increased symptoms and the fact that I have persistent and visible inflammation in my wrist, my doctor decided it was time for a change. I have been taking Enbrel for over 4 years now. It has worked wonders for me, and although it may not be working as well as it once did, I know it’s still doing a lot. Because of this (and because I’ve had no ill effects from the Enbrel) changing meds is a big deal for me, and kind of a scary process. The doctor basically laid out 4 options:

1. Add methotrexate
2. Add low-dose prednisone
3. Add plaquenil
4. Switch from Enbrel to Humira

I don’t want to be on methotrexate at this stage in my life, so I asked him, “If methotrexate isn’t an option, what would you recommend?” He didn’t seem too keen on the idea of adding prednisone, although he did cite that a fair percentage of RA patients are on it long-term. Because I had tried plaquenil for a short period of time in the past and it didn’t seem to do much, he wasn’t convinced that was the answer, either. So, he settled on Humira, and I decided I was comfortable with that choice.

Let me back up a second. Enbrel is considered a biologic DMARD (disease modifying anti-rheumatic drug), and more specifically it is a TNF blocker – meaning that it targets a particular protein (TNF-α) involved in immune function. In people with rheumatoid arthritis, the body produces too much of this protein and it can attach to and attack healthy cells, causing inflammation. From my understanding, Enbrel works by binding to the TNF molecules, thereby preventing them from attaching to healthy cells. I like to think of it as a shield. The TNF launches an “attack” on the rest of my body, but Enbrel acts as my shield to block the attack. Humira works in much the same way, only it’s a different type of protein. For some people one medication is more effective than the other. However, like my doctor said, the only way to know is to try it. And since my Enbrel seems to be letting down its guard, I’m going try Humira and hope for a new and better shield!

I start the Humira today. It’s an every other week injection instead of every week like Enbrel. I will take two shots (over 1 month) then go back in for some blood work and see what that shows…and see if I can feel a difference. Wish me luck!

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Hi there! My name is Dana and I live in West Michigan with my husband, Tom and our dog Copernicus. I created this space as a place to share the things I learn along this journey I call life. I work in marketing and I'm a sort of Jane of All Trades, interested in all things nature, gardening, cooking, exploring and learning new things. This blog is a conglomeration of my interests, hobbies, life and life lessons. Thanks for stopping by!