While biologic medications have revolutionized the treatment of many kinds of arthritis, like all drugs, in addition to their benefits, they come with new risks. Biologic drugs work by suppressing the immune system, an action that can open the door for infections.
We asked Arthritis Today Medical Advisory Board member Robert Shaw, MD, an instructor of medicine at Johns Hopkins University and a practicing rheumatologist, what precautions people with arthritis should take before starting a biologic medication. Here is his checklist:
1) Have a skin or blood test for tuberculosis, or TB.
Experts estimate that 90 percent of people who are infected with tuberculosis, which can cause a deadly infection, don’t know it because the bacteria can lie dormant in the body for years. Taking medications that suppress the immune increases the risk that the infection will become active.
2) If you need any live virus vaccines, get them one to three months before starting biologics.
Flu vaccine injections are dead viruses and can be given anytime. But any live virus vaccine needs to be given one to three months before starting immunosuppressant drugs. Discuss how to handle live virus vaccines with your doctor, including:
• Flu Mist vaccine, which comes in nasal form
• Shingles vaccine
• Measles, mumps and rubella vaccines
• Typhoid, varicella, small pox and yellow fever vaccines for people who need to travel
3) Finish antibiotics before starting a biologic.
Anyone with any infection or fever who is on antibiotics should not start a biologic until the infection and fever have passed because your immune system is impaired.
4) Wait if you are going in for surgery.
Dr. Shaw says patients going in for surgery should hold off on biologics like etanercept (Enbrel) and adalimumab (Humira) for two weeks before surgery and they should hold off on infliximab (Remicade) and abatacept (Orencia) for four weeks before surgery. Additionally, patients should not start or restart the biologics until after their sutures or staples are removed and there is no sign of infection because biologics will make it harder to heal.
5) Get scanned before you take rituximab (Rituxan).
Dr. Shaw says patients should have a Hepatitis B scan before going on Rituxan because the drug impairs immune system cells called B cells and that predisposes people to hepatitis. If you are harboring the Hepatitis B virus, it will make you worse.
And in responce to everybodys questions about humira its absoloutly brilliant it gives you super powers so you can run up walls, and you live forever when your on it its like everlasting life in a preloaded pen
I'm sorry you are in pain but biological drugs are not for you. They are serious meds and can cause serious complications. I would search out 2nd, 3rd, 4th or even 5th opinions to find someone who's willing to help you more than your current docs.
I'm thinking of starting on Rituxan because nothing else has worked for me and I'm only 20. I was wondering what to expect when I first start these infusions and I'm also married and like any person I want a family, will Rituxan interfere with that? Does it have to be out of my system for me to have kids?
Thanks!
Should I discontinue the biologics or delay the next dose (and how long to delay?).
Great question. I contacted a member of our medical advisory board for the answer.
He is Dr. Robert Shaw, MD, a rheumatologist at Carroll County Arthritis and Osteoporosis Center in Baltimore, and here's what he had to say:
The MMR vaccine is a live virus. So far, there is no evidence of person-to-person transmission from a vaccinated child to a patient in the biologic population. However, it is recommended that people on biologics avoid body fluids (changing diapers, kissing) in children who have received this vaccine. Holding the child is just fine. Immunity to MMR occurs in 1-1/2 to 3 months, so body fluids should be avoided during that time period of virus shedding. I would recommend waiting a full 3 months.
With the varicella vaccine (or if child is sick with chicken pox) there is a risk of the biologic patient developing shingles or adult chicken pox. In that case, the recommendations are more stringent. There is no holding of the child or skin-to-skin contact allowed. Avoid urine, fecal and oral contact for 3 months in the case of vaccine or until the child has recovered from the chicken pox.
Hope that was helpful.
Best,
Brenda
Thanks,
Kelly
www.rawarrior.blogspot.com
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