Off On Another Medical Adventure

Since rheumatoid arthritis made an entrance into our lives in 1973, I have had a continual parade of therapies. The late Dr. Saville started me on the "standard" treatment at that time - the salicylates. I took over 20 aspirin per day. I was lucky that it did not have an adverse effect on my tummy.

I remember the names of the drugs well. When one drug therapy failed, we hopped onto another chemical path. There was an assortment od DMARDs (Disease-modifying antifheumatic drugs). The early one consisted of injections of gold salts. Soon I was introduced to such drugs as Cuprimine (penicillamine), Plaquenil (hydroxychloroquine), and my old friend Methotrexiate.

I have been injecting Methotrexiate for many years. Dr. Saville assured me back in the 70's that I did not need to travel to his office in Charleston for the injections, but could just administer them myself. I remember Dr. Saville's words after I had some apprehension. 'For heaven's sake, if the druggies on the street can administer shots, you can do it!' Methotrexiate is used in association even now with the newest therapies.

For decades, I have taken a special class of RA medicines called corticosteroids. I take a daily dose of prednisone and have had cortisone injections in the shoulders and knees when extreme swelling occurred. They work well, but one has to be especially areful in taking high doses to alleviate pain.

My last drug for RA consisted of weekly injections of the biologic drug, Enbrel (etanercept). It worked wonderfully for a while. As you can imagine, ALL of these drugs may cause SERIOUS side effects. The Enbrel caught up with me on the side effect issue. Dr. Craig, my wonderful oncologist, believes the cause of my Hodgkin's lymphoma was Enbrel.

Today I am having infusions of Rituxin. This seems my only option at this time. I have read the serious side effects. The quality of life is the prime focus here. I am having RA symptoms that have limited my mobility because my knees, shoulders, hands, etc., have been swollen and painful. We want the opportunity to travel once again to special places with a return visit to Yellowstone National Park being my first choice. Then the list will continue until I am no longer above grass.



Rituxin is a monoclonal antibody that is directed against CD20, a protein that is specifically found on B cells, a type of white blood cell. B cells are instrumental in causing inflammation of RA and can develop into the cells that make autoantibiodies in autoimmune diseases. Rituxan is given by IV infusion and depletes the B cells.

Rituxan has been shown to work in RA to prevent symptoms and also help heal joint damage. The medicine is given as 2 doses 2 weeks apart. Each infusion may take up to 5 hours. Unique to other drugs, Rituxin is not given again until a patient starts to flare and many patients can go as long as a year before needing another infusion. Side effects range from infections, tumors, or even death - but we are not voting for the last consideration. As always, Methotrxiate will always accompany me.

As always, I shall keep you posted on our medical adventures.