Question about WBC

[Guest guest]

My rheumy called yesterday to say that my blood work shows a lowered

WBC. She said to continue on the MTX and that they will do blood

work again when I see her on Oct. 20. She says if the WBC is still

low, I will have to back off on the increased dose of MTX.

My question is: Wouldn't it be expected that if you lower the

immune system you would see a decrease in WBC? Why would this

indicate a need to back off the MTX? Isn't it just a sign that the

MTX is doing its job?

(If I had thought of this sooner, I'd have asked the rheumy - and I

will ask her on the 20th, but would appreciate your thoughts in the

meantime.)

Also, the last few days the fatigue is back. And the nausea. Could

either of these be a result of the lowered WBC? I know that a

lowered RBC could be a sign of anemia which could cause fatigue, but

what about WBC?

I'm hoping my excitement about feeling better is not short-lived!

I'm still optimistic.

thanks,

sherry z

[Editor's Note: Great question and certainly one to discuss with your doctor,

but I think the goal here is to do a delicate balancing act. You want the

immune system to stop fighting your own body, but you still need an immune

system to prevent and fight infection. It sounds as if your doctor is concerned

that the balance may be swinging in favor of infections if your WBC is too low -

hence he/she wants to see it stay within a range. The biologics, rather than

MTX, work by blocking g a type of protein called a tumor necrosis factor (TNF)

that your body's immune system makes. People with psoriatic arthritis and

psoriasis, have too much TNF in their bodies. Enbrel, Humira and Remicade can

reduce the amount of TNF in the body to normal levels, helping to treat your

disease. However, in doing so, the biologics can also lower the ability of your

immune system to fight infections. MTX, I believe, targets the immune system

much more broadly which probably makes it more apt to reduce your WBC is true

for the biologics. Numerous studies have now shown that MTX AND

Enbrel/Humira/Remicade taken together is more effective than either medication

taken alone and this may well allow you to take a lower dose of MTX because you

would also be taking a biologic to target the TNF. It sounds like a good chat

with your rheumy about pros, cons and next steps might be timely. Kathy F.]