RESEARCH - Are steroids a consistent risk factor for infections in RA patients using MTX and Enbrel?

[Guest guest]

Clin Ter. 2009 Mar-Apr;160(2):121-3.

Are glucocorticoids a consistent risk factor for infections in

rheumatoid arthritis patients under treatment with methotrexate and

etanercept?

Luzi G, Laganà B, Salemi S, Di R.

II School of Medicine, Sapienza University of Rome, A.O. Sant',

Rome, Italy.

Abstract

OBJECTIVE: To evaluate the incidence of infections in subjects with

rheumatoid arthritis (RA), treated with an anti-TNFalpha blocker

during one year follow-up. The aim of the study was focused to

evaluate the number of infectious episodes in two groups of patients

treated with etanercept (ETN) plus methotrexate (MTX) or ETN plus MTX

and glucocorticoid drugs (GCs/prednisone) for a 12 months period.

MATERIALS AND METHODS: Sixty-nine out of 122 RA patients treated with

an anti-TNFalpha drug (ETN) were included in an outpatient control

system within the Immunology Department Sapienza-University of

Rome-II; School of Medicine. RA patients were studied during the first

year after ETN introduction. Particularly 20 RA patients have been

included in a subgroup. For these 20 patients infections have been

monitored for 2 years: 12 months before and 12 months after ETN

treatment starting.

RESULTS: According to drugs administration protocols, after a careful

screening aiming to exclude latent tuberculosis infection, 20 patients

have been treated with ETN (10 of them received treatment in

association to MTX, while 10 were given a GCs therapy plus MTX).

During the one-year ETN treatment period, 7 infections have been

described in the group treated with ETN, MTX and GCs and no infection

in the group treated with ETN and MTX. After analysing the infection

number in the two groups of patients, in the year preceding biological

treatment no significant change arose.

CONCLUSIONS: The risk of infections in subjects treated with the

biological drug ETN is well known. Our data show that after one year

therapy the [ETN+MTX+GCs] group is marked by a greater frequency of

infectious episodes compared to the subjects treated with ETN plus

MTX. Therefore, the additional infectious risk appears to be related

to steroid therapy itself, though infections were not serious.

PMID: 19452100

http://www.ncbi.nlm.nih.gov/pubmed/19452100

Not an MD

[Guest guest]

Hi Group:

This is an interesting topic for me, not only for infections, but atrophy and

the dying off of my adrenal glands. Out of NOWHERE, Thanksgiving, I got

crushing chest pain, which was pleurisy and two blood clots and landed in the

hospital and then coumadin-therapy hell. Thank god for the chest pain, because

they found the two blood clots on CT Scan.

I saw my Rheumy the other day and she said that my RA was under control and lets

get me off Prednisone, because I expressed concern over this very topic and also

that my glands are being atrophied by so much Prednisone, so she lowered my

dosage, because you have to get off Predni slowly. I am looking forward to

DUMPING this soon!

Steriods are god-sends for RA and devil-sends for our glands, at the same time!

OKD

[Guest guest]

OKD,

Did any of your physicians have any theories about the origin of your clots?

Not an MD

On Mon, Feb 7, 2011 at 9:20 AM, OKD <Cofade_2000@...> wrote:

> Hi Group:

>

> This is an interesting topic for me, not only for infections, but atrophy and

the dying off of my adrenal glands.  Out of NOWHERE, Thanksgiving, I got

crushing chest pain, which was pleurisy and two blood clots and landed in the

hospital and then coumadin-therapy hell.  Thank god for the chest pain, because

they found the two blood clots on CT Scan.

>

> I saw my Rheumy the other day and she said that my RA was under control and

lets get me off Prednisone, because I expressed concern over this very topic and

also that my glands are being atrophied by so much Prednisone, so she lowered my

dosage, because you have to get off Predni slowly.  I am looking forward to

DUMPING this soon!

>

> Steriods are god-sends for RA and devil-sends for our glands, at the same

time!

>

> OKD

[Guest guest]

No, they didnt offer me any theories, but I have several. I have no idea how I

got pleurisy, let alone two blood clots, I have never before had any type of

problem. Thank god I didnt have fluid in my lungs, only the inflammation, but

BOY O BOY does it hurtm crushing chest pain, ugh....

I guess now i have thick blood and I dont mind telling you Coumadin therapy is

awful. i have been on it since thanksgiving and the Coumadin leaves you queasy,

nauseous and craving since you cant eat anything green, or with Vit. K (i.e.

mayonnaise). My Rheumy did want to get me off prednisone (slowly) and I cant

help feeling like it might be the culprit, although as you read more and more,

Enbrel could be guilty too. MTX seems relatively safe for RA patients.

I just know I never want to go thru that again. RA Lung issues, I dont mind

telling you, scare me!

OKD

[Guest guest]

Prednisone really helped the pain a lot, but it caused me to have mood

swings. (I have bipolar disorder) The mood swings were not as extreme as the

the ones I had when I was not on a mood stabilizer, but they were still

troublesome. Add to that the fact that it causes so many problems, I decided

to get off of it. Yes, there is more pain now, but that is a trade-off I am

willing to live with. I don't want to risk my health.

On Wed, Feb 9, 2011 at 9:39 AM, OKD <Cofade_2000@...> wrote:

>

>

> No, they didnt offer me any theories, but I have several. I have no idea

> how I got pleurisy, let alone two blood clots, I have never before had any

> type of problem. Thank god I didnt have fluid in my lungs, only the

> inflammation, but BOY O BOY does it hurtm crushing chest pain, ugh....

>

> I guess now i have thick blood and I dont mind telling you Coumadin therapy

> is awful. i have been on it since thanksgiving and the Coumadin leaves you

> queasy, nauseous and craving since you cant eat anything green, or with Vit.

> K (i.e. mayonnaise). My Rheumy did want to get me off prednisone (slowly)

> and I cant help feeling like it might be the culprit, although as you read

> more and more, Enbrel could be guilty too. MTX seems relatively safe for RA

> patients.

>

> I just know I never want to go thru that again. RA Lung issues, I dont mind

> telling you, scare me!

>

> OKD

>

>

>

[Guest guest]

Did they say you have antiphospholipid antibodies (e.g.,

anticardiolipin antibodies), OKD? Just wondering.

Not an MD

On Wed, Feb 9, 2011 at 8:39 AM, OKD <Cofade_2000@...> wrote:

> No, they didnt offer me any theories, but I have several.  I have no idea how

I got pleurisy, let alone two blood clots, I have never before had any type of

problem.  Thank god I didnt have fluid in my lungs, only the inflammation, but

BOY O BOY does it hurtm crushing chest pain, ugh....

>

> I guess now i have thick blood and I dont mind telling you Coumadin therapy is

awful.  i have been on it since thanksgiving and the Coumadin leaves you queasy,

nauseous and craving since you cant eat anything green, or with Vit. K (i.e.

mayonnaise).  My Rheumy did want to get me off prednisone (slowly) and I cant

help feeling like it might be the culprit, although as you read more and more,

Enbrel could be guilty too.  MTX seems relatively safe for RA patients.

>

> I just know I never want to go thru that again.  RA Lung issues, I dont mind

telling you, scare me!

>

> OKD

>

[Guest guest]

Yes, they did. They think I have antiphospholipid syndrome, they are not

sure yet. I have to undergo different scans after the coumadin, to make sure i

have no more blood clots anywhere and also if I have this syndrome that has

lingered continue on the blood thinners, they test that with blood tests.

I am told antiphospholipid syndrome is ANOTHER damn autoimmune disease.

OKD

[Guest guest]

OKD,

It is possible that Enbrel caused the antiphospholipid antibodies to

form, which in turn caused the clots.

This article is worth a read:

******************************

Journal of Medical Case Reports 2010, 4:12doi:10.1186/1752-1947-4-12

" Etanercept and venous thromboembolism: a case series "

http://www.jmedicalcasereports.com/content/4/1/12

******************************

Not an MD

On Thu, Feb 10, 2011 at 10:48 AM, OKD <Cofade_2000@...> wrote:

> Yes, they did.  They think I have antiphospholipid syndrome, they are not

sure yet.  I have to undergo different scans after the coumadin, to make sure i

have no more blood clots anywhere and also if I have this syndrome that has

lingered continue on the blood thinners, they test that with blood tests.

>

> I am told antiphospholipid syndrome is ANOTHER damn autoimmune disease.

>

>

> OKD

[Guest guest]

!!

Wow, you are " johnny-on-the-spot " with the 411!!!

Thanks, I am gonna send this to my Rheumy ASAP.

OKD

[Guest guest]

You're welcome, OKD. It's worth pondering whether there is a connection.

I'll send a couple more articles separately.

Not an MD

On Fri, Feb 11, 2011 at 9:55 AM, OKD <Cofade_2000@...> wrote:

> !!

>

> Wow, you are " johnny-on-the-spot " with the 411!!!

>

> Thanks, I am gonna send this to my Rheumy ASAP.

>

> OKD

[Guest guest]

hi :

Ugh, dotn know what to do now, i am concerned. jut when i think i am getting

better because of the enbrel, i read that it may cause pulmonary embolisms and

other ayndromes. My rheumy is on vacation, i am not sure if i want to continue

enbrel now, and i am afraid if i dont.

Do I report what happened to me to the Enbrel people as well? Do I got off for

a few weeks? I am alreasy lowering the steroids, maybe i can just subsist with

the MTX?

I never thought the god-send, enbrel might have caused my two blood clots, i

never want to go thru that again.....and when u read the warnings they mention

lymphoma as well, but very little about antiphospholipid syndrome or blood

clots.

I refuse to live in fear....but pleurisy is no fun at all either.

OKD

[Guest guest]

OKD,

I'm so sorry. Try not to worry. Isn't there anyone filling in for your

rheumatologist with whom you could speak?

It's not a certainty that it was the Enbrel. Just a possibility.

You are still on Coumadin, right? That changes the equation.

I would report what happened to the manufacturer and/or FDA's Medwatch.

Not an MD

On Sat, Feb 12, 2011 at 1:17 PM, OKD <Cofade_2000@...> wrote:

> hi :

>

> Ugh, dotn know what to do now, i am concerned.  jut when i think i am getting

better because of the enbrel, i read that it may cause pulmonary embolisms and

other ayndromes.  My rheumy is on vacation, i am not sure if i want to continue

enbrel now, and i am afraid if i dont.

>

> Do I report what happened to me to the Enbrel people as well?  Do I got off

for a few weeks?  I am alreasy lowering the steroids, maybe i can just subsist

with the MTX?

>

> I never thought the god-send, enbrel might have caused my two blood clots, i

never want to go thru that again.....and when u read the warnings they mention

lymphoma as well, but very little about antiphospholipid syndrome or blood

clots.

>

>

> I refuse to live in fear....but pleurisy is no fun at all either.

>

> OKD