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Is There A "Light" TNF Inhibitor?
#283675 10/19/19 04:38 PM
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Okay, so this is a bit of a spin off from my Claritan D post but I wanted to put this question out to the members of the forum. I know that this is something I should be discussing with my rheumatologist but she is booked through the end of April and is not scheduling any appointments out any farther than that. (Which is a different issue entirely.)

I feel like I'm onto something when it comes to the treatment of my psoriatic arthritis. As I noted in my Claritan D post, Claritan D takes my pain away to a large extent. Not entirely but maybe 80% of it. I never understood why this was until Winston mentioned that he'd read about an animal study that concluded pseudoephedrine may reduce inflammation by inhibiting TNF-a production. But there are (blood pressure) issues with taking a stimulant long term.

Humira worked like gangbusters on me but make me sick and nauseous. It was like using a fire hose to put out a small fire on my stove. Just WAY more TNF inhibition than I needed. So my question is this ...

Is there something in-between?

Is there something that would be safer and more effective, and slightly stronger, than taking a Claritan D every day but that isn't the full on assault on TNF production that Humira is? Is there a drug that works like Humira but that isn't nearly as strong? Because it would seem I only need something mild. But I don't know what that drug is. So I opening up this question to the forum.

Anyone have any ideas? Thanks in advance!

Last edited by MichaelSean; 10/19/19 04:41 PM.
Re: Is There A "Light" TNF Inhibitor?
MichaelSean #283676 10/20/19 08:22 PM
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If you research there are meds that lower TNFa. I remember Buproprion and I think even fexofenadine. High dose fish oil and maybe high dose vitamin A. Research first though because I looked this stuff up years back. I do the EPA and vitamin A.

There are some folks who use reduced doses of biologics. I have heard of Enbrel being taken once every 3 or 4 weeks instead of weekly. I suspect this is going to be me with Cosentyx or Taltz. I am tantalized by the experience where I stopped Cosentyx and the side effects were gone before the pain came back

I have even had an increase in pain just in the past two weeks. Today I got desperate and took a shot of Cosentyx. I hate getting to that point where you are desperate and will grab at whatever gives you relief. I took pain medicine on the job Friday. I've gone gradually from twice per month to twice per week and now every other day(pain meds). It's usually just tramadol with apap but a few weeks ago I had to break into the Norco stash. This won't work. So I took the shot. I won't take another one anytime soon but I had to try. My mind was running through the things I had done. I forgot my chair cushion on Thursday or I got overheated yesterday but in the end the pain was too intense and nothing was working so I had to give it a shot-all puns intended.
Danielle


25 years a pharmacist HLAB27+(thanks dad!)iritis at 17, plantar fasciitis at 22, sacroiliitis at 25,first image at 31,diagnosis of AS at 48(hello medical community!!) it's all been downhill since (Cosentyx(waiting on Taltz)Celebrex,Trazodone,Tramadol,benztropine(antispasmodic), high Omega3,A&D to tame immune system,quercetin,bromelain) previous meds were Enbrel Humira Simponi
Re: Is There A "Light" TNF Inhibitor?
MichaelSean #283677 10/21/19 12:42 PM
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Enbrel is available in 25 mg doses, as opposed to the usual 50 mg adult dose. Enbrel isn't usually prescribed to people with any history of uveitis or IBD though.

Re: Is There A "Light" TNF Inhibitor?
MichaelSean #283678 10/21/19 01:26 PM
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Thanks for the responses. I didn't know if TNF inhibition was more akin to analog or digital. When something is digital it's either on or it's off. A 1 or a 0. There's no dialing it in. Analog, on the other hand, can be modulated. So I didn't know if the drugs worked by turning it off entirely or worked by just tamping it down. Because that's what I'm looking to do ... just tamp it down lightly with as few side effects as possible.

Re: Is There A "Light" TNF Inhibitor?
MichaelSean #283680 10/22/19 02:18 PM
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Wikipedia has a statement that apremilast inhibits "spontaneous production" of TNF-alpha. Not sure what that means. However, since the elimination half-life is 6-9 hours (vs Humira which is 10-20 days). This seems better if you just need it occasionally so you better can control the daily absorption.

I think "Cimzia" is supposed to have a different mechanism of action than Humira, still lowering TNF-alpha though. Maybe that could be meaningful to the treatment of your symptoms? In the end of the day, it seems that we are all left out to how our bodies will respond to a particular medicine. The more I read about the body the more fascinated I am that it works in the first place. So, I am not jealous at the medical researchers who are trying to figure out how to alter complex, biologically-driven processes in patients that all have different symptoms and different genetic codes.


Background: 31 yr old male
Symptoms: Ps (scalp, elbows, knees) since 2000; PsSpa (neck, sacroiliac joint) since 2015
Dx: Osteoarthritis Aug, 2017; PsSpa Nov, 2018
Treatment: Meloxicam, Nov 2018-Jan 2019; Naproxen, Jan 2019-Jun 2019; Humira, Jun 2019-Present
Re: Is There A "Light" TNF Inhibitor?
MichaelSean #283682 10/23/19 03:06 PM
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I've been thinking about apremilast (Otezla) as an option. I like that it's a pill and that there are no routine blood monitoring requirements. Quite honestly, getting my blood tested every couple of months caused me to have health anxiety. And it's approved for the treatment of psoriatic arthritis.

My orthopedist (who is great) is helping me to find a new rheumatologist. One I can actually get into see. So this will be an option I'll be discussing once I land an appointment.


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