I had a TB test done before starting a biologic. Is your doc changing your treatment?

Maybe that is his plan (though he hasn't told ME yet). I see him next week and am only on methodex right now. I was hoping that is enough. The biologics just scare me to death.

The immune system suppressants taken for RA can throw a latent and untreated case of TB into an active state. The test is necessary. Even if you come up positive for TB antibodies, you may be given a course of antibiotic treatment geared for that disease before you start on the RA drugs. I actually had TB as a child but was treated in my 20's. I take MTX and a biologic and have had no problems despite my history.

it's like mapractice or some such small thing if they don't. smile. it's the standard of care before some dmards and when switching to from biologics. i've had the test umpeteen million times lets use hyperbole so early in the morning every time I change a biologic and there is that break in between. it's on the doc's checklist. so you will be having many more in the years ahead as you switch between biologics. uncontrolled ra and inflammation from ra and lack of walking function scares me to death also. get a wicked good ra book used from the library or amazon and read read read so that you are ahead of your doctor when she is prescribing question and information wise. this is your new child in the family or a part time job :). ask your rheum to run off the paperwork in her/his office on the biologic proposed and the methodology for his/her thinking. bring a best friend if you think you may not retain the information - i sometimes go to a best friend's ra appointment - yeah I have a best buddy who has this stupid disease also, go figure. and she does NOT listen. by sitting sentry i can tell after that she has interrupted, not listened. and only retained like 10 percent of what her rheumatologist said. i'm slightly better. we all could use a medical tag along.

depot

And why, Susie, are you scared to death of biologics?

I had one before my first biologic, but in Canada, I guess they figure by my age if you haven't had TB you probably won't get it!

My daughter had a friend with lupus and they tested her before putting her on a biologic. Turns out she did have latent TB. She picked it up on a mission trip to help kids in Mexico, they think. Because there was no where else she could have been exposed. She was supposed to go on this long antibiotic protocol. In the end, between college and work, she didn't do the protocol. She also decided to take NSAIDS, as her lupus was quite mild. She is a model, and mthx discoloured her skin, and she couldn't afford to gain weight.

Well, med free is always a choice. Except that she is disabled, can't work at all, her stomach and kidneys are damaged from the NSAIDs and she is exhausted. Who knows what else is going on inside her? The folly of being afraid of the big drugs that actually do the job, instead of fearing the disease and the DMARDS!

I get it. It's biologics or become a cripple. Sounds like a no brainer, right? I guess I'm still in some denial. Like I will be the exception to this disease'S rules. I just pulled out my insurance paperwork in prep for tues appt. Lots of pre-Auth coordination about to start.

Good for you, Susie! Just take it one step at a time. When the biologics start to work, and no side effects (hopefully!) you will wonder why you ever were afraid of them!

Susie, when I started Humira I had NOT ONE SIDE EFFECT.

It's like an automatic garage door. You spend years manually opening and closing the garage door. Then one day you decide to bite the bullet and get an automated system installed. Then you want to kick yourself in the butt for waiting that long. :-)

On the TB test: I have latent TB. I was exposed to an uncle who came home from the Korean War with TB before they shipped him off to a TB sanitorium. That was 65 years ago.

About 6 years ago, when MTX was no longer doing its job [I'd been told I could not take a biologic because of the latent TB] I spoke to the head TB specialist at Johns Hopkins. He told me that he had seen cases where someone came down with TB 75 years after he had been exposed.

[You're going to ask....so how did I get on Humira?]

For most people in my situation, if you're under age 55, you can start the TB treatment and about a month after that, start the biologic.

However, since I was over 55 at the time, the TB treatment was contraindicated for me UNLESS I came down with full blown TB [which was possible].

At my wits' end, I begged my rheumatologist and Infectious Disease specialist to let me start Humira, and if I experienced anything that VAGUELY seemed like a TB symptom, I would stop the Humira and call them.

They know I'm into medical information and they trusted me enough to let me do it. I've been on Humira 6 years.

Is Humera one of the self injectibles? I see finagling in my future with doc, me and ins co. Right?

So mtx and humera?

yeah it's common to have both a dmard and a biologic together, sometimes my rheum calls it a synergistic effect...it is also common to have a stand alone dmard and /or a stand alone biologic.

every single case of ra is unique and has its own treatment regime and lots of folks are not in wheelchairs or with ulnar deviations and loss of physical function impairment and some are. maybe you will not be. take your time. process learn, think and ask your doctor.

your case is unique.

some of the biologics can be administered by infusion (iv) some can be administered by pill (xeljanz) some can be administered by your self injection. some have a monthly schedule. some have a weekly schedule. some have an every other week schedule. some folks have insurance that precludes infusion. some folks have insurance that only covers it by infusion or only covers it by injection. pre-admission review runs through a dummy claim and gives you insurance payment answers. some folks have only government insurance like a safety net. some folks have group commerical insurance. some folks use commercial insurance co-pay programs through the pharmaceutical company, some don't. some don't mind giving themselves weekly shots, some wail like a baby. some are still working full time and need best possible physical function and some are retired. there is no one answer because you are so unique.

it is common to start on a biologic that is a anti TNF (tumor necrosing factor) so enbrel OR humira are usually but not always since you are unique, the first line of biologic. methotrexate could stand by in the concurrent position or not, that's up to you and your doctor. buy a used book on ra from amazon and /or check one out from the library. i had about 5 on the coffee table when diagnosed and tried to get best friends to take one home as I finished each one. it's rewarding to read up before so you can ask the questions as the rheum dishes out the new information. in a year you will be able to write a self help pamphlet.

there is no easy way to circumvent the self learning curve for you.

depot

Hah! After 25+ years of RA I'm STILL learning!

True - MTX provides a synergistic effect when administered with most biologics.

In my case, I had been on 25 mg of MTX prior to adding Humira. When they added the Humira, they dropped the MTX to 7.5 mg. That diminshed most of the TX fatigue [in my case].