Medication
- All medications have risk and those we use in rheumatology are no exception
- The question becomes do potential benefits outweigh potential risks
The potential benefits generally revolve around increasing function, decreasing pain, and limiting further irreversible damage to joints
Most medication we use takes 3-6 months to fully get into the system
- Examples include Humira, Methotrexate, Xeljanz, Cosentyx, and many others
- Roughly speaking we see a benefit in 65-70% of people who try these agents
- Prednisone and NSAIDs (i.e. ibuprofen, naproxen) are the exception- they work quick
The number of “under 1%” risks for many medications is quite high and immunosuppressives (IS) are no different
- The bottom line: If you develop a new symptom after starting a medication let us know
Concerns
Infection is an important risk to be aware of, including:
- Published literature demonstrates increased rates of URIs (i.e. common cold, bronchitis) by about 20% (i.e. 1 extra cold/bronchitis per year)
- While rare (in the “under 1%” range), life threatening infections have been reported
Cancer is always a theoretical concern when considering IS
- The immune system targets bacteria/viruses as well as cells gone rogue (i.e., cancer)
- Use of IS in active cancer is typically avoided; recent cancer necessitates further discussion
- There is an increased risk of skin cancer, so an annual dermatology visit is recommended
- The most convincing literature is around non-melanoma (i.e., not the scary skin cancer); this risk is increased with most immunosuppressive meds
- There may be a small increased risk of melanoma with certain IS meds
- It is not clear lymphoma risk is elevated with IS use, though an FDA warning persists
Refer to specific medication handouts or the following websites for more information: American College of Rheumatology, Creaky joints, and the Arthritis foundation
