Tuesday, October 4, 2022

Does Otezla Treat Rheumatoid Arthritis

Ra And Methotrexate: Does Methotrexate Reduce Inflammation

Rheumatoid arthritis – causes, symptoms, diagnosis, treatment, pathology

Jump to:RA TreatmentMethotrexates HistoryPossible Side Effects Folic Acid & MethotrexateDosingIs Methotrexate for You?

If you have rheumatoid arthritis , youre probably very familiar with the pain and joint swelling that this particular type of arthritis can cause. If youve had it for some time, you may even be experiencing the joint deformities that can occur as RA progresses. As you know, any joint deformity can take a significant toll on your joint function as well as your overall quality of life.

RA usually attacks the joints of the hands and feet first, which means even simple activities like tying a shoe, brushing your teeth, combing your hair, or getting dressed in the morning can become painful enterprises. Leisurely pursuits like gardening or taking long walks may have lost their appeal as well, largely as a result of the pain and inflammation these joint-based movements can trigger.

Although there is currently no cure for RA, there are medications that a doctor can prescribe to slow the progression of joint destruction and deterioration. One of the most popular and also most effective of these is a folate analog called methotrexate . Its a treatment option with one of the longest and most well-established safety profiles of any rheumatoid arthritis drug on the market.

So What Is Psoriatic Arthritis And How Does It Differ From Rheumatoid Arthritis

Well, just like rheumatoid arthritis, it is an auto-immune disease. Both cause an erosive inflammatory arthritis in addition to chronic fatigue. And both can have symptoms that vary greatly from person to person. However the distribution of joint involvement differs between the two diseases and psoriatic arthritis involves the skin as well as the joints.

Both diseases can cause destruction of the small joints in your hands and feet as well as larger joints such as knees, hips, shoulders and even the vertebrae in your spine. Classic rheumatoid arthritis primarily involves the PIP joints and wrist, and is generally a symmetrical disease effecting both sides of the body equally. Also with rheumatoid arthritis, nodules specific to this disease are often present.

Both diseases can involve inflammation and scarring of major organs such as your heart and lungs and as in my case can involve your eyes. In addition, both can increase your risk of osteoporosis due the condition itself and also from some of the medications that are used to treat these conditions. After years of taking steroids for my arthritis, it resulted in a couple of compression fractures in my thoracic spine. And, both disorders can also result in joint destruction leading to severe crippling disabilities.

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Other Dmards And Nausea

Leflunomide

If methotrexate alone isnt controlling your RA symptoms, doctors will often prescribe leflunomide . Leflunomide is usually given alone as a once-daily pill. It can cause nausea, though its usually not as bad as with methotrexate, Dr. Rosian notes. Theres another side effect that might be even more challenging for patients. While queasiness is up there, the biggest reason that people cant tolerate leflunomide, GI-wise, is diarrhea, says Dr. Rosian. Its still treatable, but not as easily as nausea is.

Hydroxychloroquine

Hydroxychloroquine is usually given to patients with mild forms of RA or in combination with other medications for more severe cases. It is also widely used to treat lupus. It can upset your stomach, giving you a queasy feeling. Generally if people can hang in there, even on one a day, they tend to be able after the first month to manage the nausea. I dont know if their body adjusts to it, but it rarely continues to give them problems, says Dr. Rosian.

Sulfasalazine

Most patients can take sulfasalazine with few side effects, according to the American College of Rheumatology, though the most commonly reported are nausea and abdominal discomfort. They tend to occur early in the course of treatment, usually improve over time, and may be avoided or minimized by increasing slowly from a low starting dose.

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Financial And Insurance Assistance

If you need financial support to pay for Otezla, or if you need help understanding your insurance coverage, help is available.

Amgen, the manufacturer of Otezla, offers a copay card that may reduce the cost of Otezla. The manufacturer also has a program called Otezla SupportPlus, which may assist you in finding ways to lower the cost of Otezla.

For more information and to find out if youre eligible for support, call 844-468-3952 or visit the program website.

Methotrexate And Ra Treatment

Otezla® May Be Unlikely to Work as Treatment for RA

RA is an autoimmune disease, which means that it is caused by an abnormal immune response. What does this mean? In a healthy immune system, special cells seek out and destroy harmful germs to prevent infection and disease. But in an autoimmune disease, those same cells attack healthy tissue instead, destroying it in the process.

In RA specifically, immune cells attack the tissues inside the joints. Normally, these tissues are there to help the joints function properly and to protect the joint surfaces from painful and destructive friction. Thats why RA has the clinical manifestations it does when these joint tissues are damaged or destroyed.

Disease-modifying antirheumatic drugs like methotrexate work by targeting the abnormal immune response that causes joint tissue destruction. Among the DMARDs, methotrexate is the one treatment drug which has been around the longest.

One of the primary benefits of methotrexate is that it can be combined with other drugs, including other DMARDs, to provide symptom relief when methotrexate alone isnt enough. It can also be combined with biologics, which are drugs designed to target specific aspects of the abnormal immune response that cause joint destruction to create a more effective treatment regimen.

As a result, doctors can prescribe this drug to patients in a way that allows them to receive a truly customized and personalized treatment plan based specifically on their individual needs , which is the best form of treatment there is.

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Side Effects Of Leflunomide

The most common side effect of leflunomide is diarrhea. It often gets better over time. You can take anti- diarrheal medicines to ease this side effect, or even lower your leflunomide dose.

Other side effects include nausea, indigestion, hair loss, stomach pain, liver toxicity, or skin rashes. More rarely, this drug may lower your amount of blood cells or platelets, or cause lung problems like cough or shortness of breath.

Leflunomide may also raise your risk of getting infections. Let your doctor know if you have signs of an infection, like fever or chills.

Otezla For Mouth Ulcers Caused By Behets Disease

Otezla is approved to treat mouth ulcers that occur with Behçets disease.

Behçets disease is an autoimmune disease. It causes damage to certain blood vessels that can lead to sores in your mouth, rashes, and other symptoms.

Effectiveness for Behçets disease

In a clinical study, 53% of people who took Otezla had their mouth ulcers completely cleared after 12 weeks. In comparison, 22% of people taking a placebo had that same result.

For 30% of people who took Otezla for 6 weeks, their mouth ulcers completely cleared and stayed cleared for another 6 weeks. In comparison, 5% of people taking a placebo had the same result.

Also, during the study, people taking Otezla had an average of 1.5 mouth ulcers. People taking the placebo had an average of 2.6 mouth ulcers.

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More Common Side Effects

The more common side effects of Otezla include:

  • diarrhea
  • weight loss
  • back pain

Most of these effects may go away within a few days or a couple of weeks. If theyre more severe or dont go away, talk to your doctor or pharmacist.

* This is a partial list of mild side effects from Otezla. To learn about other mild side effects, talk with your doctor or pharmacist, or visit Otezlas prescribing information.

Managing Symptoms Of Autoimmune Arthritis

How do we diagnose Rheumatoid Arthritis?

Several medications work for both psoriatic arthritis and rheumatoid arthritis:

  • Nonsteroidal anti-inflammatory medications reduce pain and swelling.
  • Disease-modifying antirheumatic drugs protect joints and slow the disease, and less of the joint is destroyed, meaning theres less swelling, pain and less loss of joint function.
  • Biologics target the specific parts of the immune system that drive inflammation.

As researchers learn more about the causes of inflammatory arthritis, theyre developing new medications to manage these diseases. Some of these new drugs are designed to specifically target one disease or the other.

Both psoriatic arthritis and rheumatoid arthritis are chronic diseases. They cant be cured, but they can be managed, Dr. Rosian says. By working with your doctor to get the correct diagnosis, you can manage symptoms to feel your best.

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Symptoms Of Psoriatic Arthritis

The severity of the condition can vary considerably from person to person. Some people may have severe problems affecting many joints, whereas others may only notice mild symptoms in 1 or 2 joints.

There may be times when your symptoms improve and periods when they get worse .

Relapses can be very difficult to predict, but can often be managed with medicine when they do occur.

Fingers Toes And Skin

Another telling clue is the presentation of the disease on the fingers and toes. With PsA, the distal joints will be the focus of pain, swelling, and stiffness. By contrast, RA primarily involves the proximal joints .

With severe PsA, the fingers can also take on a sausage-like appearance , making it difficult to ball your fist. While this can occur with RA, it is not the hallmark that it is with PsA.

Around 85% of people of PsA with also have the most typical form of psoriasis, characterized by dry, flaky skin plaques. Moreover, half will have nail psoriasis at the time of their diagnosis. Neither of these occurs with RA.

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Otezla May Be Unlikely To Work As Treatment For Ra

The psoriatic arthritis drug Otezla® does not appear effective in the treatment of rheumatoid arthritis . These Phase II study findings were published in Arthritis & Rheumatology.

Otezla is used to treat the symptoms of active psoriatic arthritis in adults. It works by inhibiting an enzyme within the immune system that can affect certain cells and contribute to inflammation in the body. In very early studies, Otezla showed potential in the treatment of RA.

To find out if Otezla was safe and effective in the treatment of RA, researchers from several institutions in the United States and Europe compared the drug with placebo in patients with RA. The Phase II study included 237 patients, who had been previously treated for RA with methotrexate, but didnt have an adequate response.

The researchers divided the patients into three treatment groups: one received placebo, one received Otezla at 20mg twice daily, and one received Otezla at 30mg twice daily. All patients received a consistent dose of methotrexate during the study.

To measure response to treatment, the researchers used the ACR Criteria, which are standard criteria used to measure the effectiveness of various medications or treatments in clinical trials for RA. The criteria compare the number of tender and swollen joints throughout the study onward to determine if patients are responding to treatment. The measure known asACR20 is used when theres 20% or greater improvement in symptoms.

Folic Acid A Must For Ra Patients Taking Methotrexate

danielleartandesign: Psoriatic Arthritis Cream

Though it may not seem like a supplement could do much to ease methotrexates potentially uncomfortable side effects, the Arthritis Foundation calls folic acid an absolute must. This is because it doesnt interfere with the drugs positive treatment effects, yet it does ease the angst that some people with RA develop in their gastrointestinal tract when taking this prescribed medication in its normal dose.

Additionally, one piece of research published in the journal Arthritis Research & Therapy explains that methotrexate toxicity can become an issue for patients with RA, especially if they take this drug over long periods. Essentially, one of the main problems occurs when it comes time for patients to be taken off methotrexate as withdrawal occurs as much as 50 percent of the time.

As a result, some doctors are hesitant to prescribe this drug as a treatment option to patients with RA. However, folic acid reduces this concern for these doctors in that it helps reduce methotrexate toxicity. Even in smaller doses, it has proven to be effective in this regard. There are other ways to reduce toxicity as well, such as by taking additional substances, like calcium folinate for instance.

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How Long Does It Take To Start Working

While everyone will have a different experience with methotrexate, research suggests that some people will notice improvements within 3months of starting the medication. For some people, it may take longer. Your provider will likely ask you to get a lab test every 2 to 4 weeks over this time period to monitor the levels of methotrexate in your body and make sure you can continue safely taking it.

Its important that you dont stop taking methotrexate unless your provider tells you to. Your arthritis symptoms may return and they may even be worse than before. After about 6 months, your provider will likely reevaluate your treatment plan if your symptoms have not improved. The next step might be trying a combination of methotrexate with another medication.

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How Does Methotrexate Work To Treat Rheumatoid Arthritis

Methotrexate belongs to a group of medications known as nonbiologic DMARDs . Examples of other nonbiologic DMARDs used to treat RA include , , and .

We dont know exactly how methotrexate works to treat RA yet, but researchers agree that it has an effect on the immune system. Methotrexate is thought to prevent your body from mounting immune and inflammatory responses. One way researchers think it does this is by blocking the effects of folic acid, a chemical that supports the production of new cells. Methotrexate may also ramp up processes in your body that counteract inflammation.

A Comparison Of Disease Burden In Rheumatoid Arthritis Psoriatic Arthritis And Axial Spondyloarthritis

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  • Affiliation Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway

  • Affiliation Norwegian University of Science and Technology, Trondheim, Norway

  • Affiliations Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway, Norwegian University of Science and Technology, Trondheim, Norway

  • Affiliation Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway

  • Affiliation Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway

  • Affiliation Jyväskylä Central Hospital, Jyväskylä, Finland

  • Affiliation Division of Rheumatology, Allergy, Immunology, University of California San Diego, San Diego, California, United States of America

  • Affiliations Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway, Hospital of Southern Norway Trust, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway

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Otezla And Other Medications

Below is a list of medications that can interact with Otezla. This list doesnt contain all drugs that may interact with Otezla.

Different drug interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Before taking Otezla, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Drug metabolism inducers

Several medications can make an enzyme called cytochrome P450 3A4 more active in your body. Taking these drugs with Otezla can cause your body to metabolize Otezla more quickly than usual. It can also make Otezla less effective.

Examples of these medications include:

Herbs and supplements can sometimes interact with medications.

St. Johns wort

St. Johns wort can make an enzyme called cytochrome P450 3A4 more active in your body. Because of this, taking St. Johns wort with Otezla can cause your body to get rid of Otezla more quickly than usual. This can make Otezla less effective.

Taking too much of this medication can increase your risk for serious side effects.

Risks Associated With Treatment Strategy

Early recognition and intervention with therapy is key to controlling disease progression in patients with PsA . The tumor necrosis factor inhibitors etanercept, infliximab, adalimumab, golimumab, and certolizumab pegol have been shown to improve signs and symptoms of PsA . Additionally, apremilast , abatacept , ustekinumab , and secukinumab have also shown varying degrees of efficacy in the treatment of PsA . Approved agents are discussed in more detail in the following section.

Treat-to-target is a therapeutic concept derived from RA and other diseases , which has been proposed for all forms of SpA . With this approach, a clear target, such as remission or low disease activity, is identified and the goal is to sustain this response over time, with an understanding of the need to treat flares and keep tight control of disease activity . A universal definition of the target is required for the treat-to-target approach and, in SpA, remission and sustained low disease activity have been suggested as possible targets . Although definitions of remission or MDA in SpA have been proposed, none have been widely accepted or endorsed and given the multifaceted nature of SpA, a composite of outcome measures may be most useful .

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