Whether we have Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, Crohn’s or Ulcerative Colitis Arthritis, Lupus, Sjogren’s, Mixed Connective Tissue Disease, Myositis, or Vasculitis. . . the underlying problem is that our own immune system has gone awry and is now attacking ourselves.
Although the root cause of autoimmune rheumatic problems has yet to be clearly defined (e.g., infection, diet, lifestyle choices, etc.), we do understand that a number of different inflammatory pathways and cells in our body are involved. It is this “active inflammation” . . . our own immune system attacking ourselves that treatment is directed toward.
Because the root cause is unknown, treatment rests on suppressing the immune system’s inflammatory response. Here’s a little history:
- First line treatment for rheumatic conditions were NSAIDs (non-steroidal anti-inflammatory drugs), which were born from the discovery of Salicylic acid in willow bark in 1760.
- 1939 antibiotics were prescribed for treatment of RA.
- From there, steroids and their potent anti-inflammatory properties were discovered in 1949.
Unfortunately, due to the significant toxicities of steroids, other treatment options were sought . . . hence, DMARDs—Disease Modifying Anti-Rheumatic Agents. DMARDs include medications such as Gold, Plaquenil, Sulfasalazine, Methotrexate, Imuran, Arava, and Cyclosporine, to name a few.
And now, we have another option, the Biologics, the first of which was Enbrel approved in 1998 for the treatment of RA.
So, what’s up with the biologics?
As we gain a better understanding of the various pathways involved in inflammation, medications (i.e., the Biologics) are now targeting specific pathways involved in producing inflammation in our bodies. This is unique when compared to how a traditional DMARD works (such as Plaquenil, Methotrexate, etc., many of which the exact mechanism of action or why they work is not fully understood).
With the biologic medications, we know what we are blocking.
When I first got out in the adult world and started playing doc, we only had three Biologics — Enbrel, Humira, and Remicade. All of which blocked a thing known as TNF, which is one type of cytokine (si – tow – kine). There are many cytokines that are active in our bodies and some are known to be responsible for creating inflammation. Furthermore, cytokines other than TNF, such as Interleukin (enter – Lou – ken) tyrosine kinase (tie -ro – seen) have been shown to be active in people with autoimmune rheumatic conditions such as RA and Psoriatic Arthritis, for example. Unfortunately, inflammation in our bodies can’t just be blamed on cytokines. B cells and T cells also play a role.
Well, it’s many years since I completed my training, and now we have MANY Biologics and can block several pathways, not just TNF. So, let’s run through the different pathways that are blocked and the Biologics that block them, shall we?
Cytokine Block — TNF Blocking:
Enbrel, Simponi / Simponi Aria,
Humira, Cimzia, Remicade
Cytokine Block – Interleukin Blocking:
Kineret, Kevzara, Actemra, Cosentyx, Stelara, Taltz
Cytokine Block – Tyrosine Kinase (Jak) Blocking:
Xeljanz, Olumiant
T cell Blocking:
Orencia
B cell Blocking:
Rituxan
Benlysta
Now you have a bit of history and understanding of what these meds are doing. Be sure to check out Part 2 of Biologics, where I’ll cover some general key features to all Biologics and then explore a few unique features to the different classes (TNF, Interleukin, Tyrosine Kinase, B cell, and T cell).
Addendum:
After getting some feedback on this post, I want to add a couple of responses regarding our current health care environment. Yes, I agree, it’s not perfect. I, too, am not a huge fan of big Pharma and big insurance companies, BUT. . .
I would love to tell you that natural remedies and healthy lifestyle choices alone would control R.A., Psoriatic Arthritis, Lupus, Sjogren’s, etc. Unfortunately, for the vast majority of patients (as well as the research that has been done), I haven’t seen that.
So, I like to think of ANY treatment we receive from providers as a bridge, taking our prescribed treatments WHILE we move to healthier choices and searching for more natural treatment options that can be equally as effective.
Also, yes, I agree, we are NOT curing anything with any of these meds and that our current health care system is not inspired to cure. Yes, there is big money in controlling rather than curing, but again, if my options are to control or not, I would choose control. After all, we know that these conditions are destructive and can affect a multitude of organ systems in our body and are not just confined to the joints themselves.
Thanks again, and remember to live your value, one choice at a time.
