Biologics

A quick note about all of the following drugs: all of them lower the immune system, which means that I have to choose between controlling my JRA and not being sick whenever I get sick. It's not an easy decision to make, but it's necessary and I don't have a choice about it.

There are two types of drugs I've always been on: one to control my arthritis (like a DMARD or biologic) and one to control daily pain and inflammation (NSAIDs).

Enbrel:

I started taking Enbrel about 8 years ago. I've been on and off of it during that time, sometimes due to my experimenting with other biologics, but mostly due to infections or surgeries. (The weeks before and after surgeries, I take Prednisone instead of Enbrel, to reduce the risk of infections.) Enbrel comes in two forms: a bi-weekly subcutaneous shot and a weekly subcutaneous shot. Both shots are subcutaneous and both work equally well in terms of controlling my arthritis.

The bi-weekly injection sites would often be red and itchy for up to a week after. Since it was a bi-weekly shot, there were often times when I could look at my thighs and see where I'd given myself the shots for the last 2 weeks. When the weekly version came out, I immediately switched. The weekly version seems to affect the injection site less: the redness and itchiness only lasts for a couple of days or less now, but the injection itself hurts while the biweekly injection didn't. Leaving the weekly shot out of the refridgerator for an hour or until it reaches room temperature has helped to reduce the pain of the injection, but it still hurts. The other major annoyance with Enbrel is that it has to be refridgerated, which makes travelling with it very difficult. Enbrel has been controlling my JRA fairly well, and it's the best biologic I've found out there for me.

Humira:

Humira is a bi-monthly subcutaneous injection. I tried it for 3 months in 2004 to see if the injection site reactions would be better with Humira than they were with Enbrel. (At the time, the weekly Enbrel had not yet been released.) The first time I gave myself the injection, I did not leave the Humira out of the refridgerator for an hour to let it warm to room temperature because I had not been told to by my rheumatologist and didn't read the directions that came in the package. (I figured that all subcutaneous shots were done the same, so I shouldn't have had a problem with Humira since I'd been giving myself Enbrel twice a week for 2 years.)

That injection was possibly the most painful experience of my life, and that's really saying something. I screamed, I cried: it was so painful that I felt dizzy, faint, and was seeing things. It also didn't seem to help my JRA much, but I gave it another try. The second time, I left it out for an hour before the injection... and, while it hurt less, it still hurt way too much. I tried it for another 2 months anyways to see if it would get better, and it didn't. Not only did the injections hurt, but the Humira also was not controlling my JRA and I ended up in a flare. So I stopped the Humira and went back on Enbrel.

Remicade:

Unlike Enbrel and Humira, Remicade is an IV drug administered every 3 months. The IV didn't hurt at all that I remember and there really wasn't a noticeable IV site reaction. I tried Remicade for about 6 months and switched back to Enbrel after that. It just wasn't controlling my JRA as well as the Enbrel had been, and receiving an IV every 3 months while I was attending a college 500 miles away from home would have been extremely difficult to arrange.