When I was first diagnosed with Rheumatoid Arthritis, my life was dictated by pain and fatigue. My rheumatologist introduced cortisone to me as my first real weapon against the inflammation raging through my joints. Cortisone brought relief, and for a while, made me believe I could reclaim the life I once knew. But as many learn, steroids are not a long-term solution to manage RA, if there is progression of the illness. 

Hydroxychloroquine is an antimalarial agent with have several pharmacological actions which may be involved in their therapeutic effect in the treatment of rheumatic disease.  

But with this debilitating disease, I still very often need cortisone treatment when pain and inflammation wreak havoc through my body. And surely, I know, the disastrous side-effects is a dark and ominous cloud gathering overhead.  

During the Covid-19 epidemic, people thought that Plasmoquin was a defence strategy against the Covid virus, and chronic users suffered severely because of the unavailability of Plasmoquin tablets.  

Cortisone is a man-made version of a natural hormone called cortisol (corticosteroid hormone). It is a naturally occurring corticosteroid metabolite that is also used as a pharmaceutical prodrug. Cortisol decreases your body’s natural defensive response and reduces symptoms such as swelling and allergic-type reactions. This medication is used to treat conditions such as arthritis, blood/hormone/immune system disorders, allergic reactions, certain skin and eye conditions, breathing problems, and certain cancers.  

The first major “switch” came, when my doctor suggested Salazopyrin (Sulfasalazine). I welcomed the change, eager to move off steroids. Salazopyrin was gentler in some ways, but my body wasn’t thrilled. I encountered persistent nausea and headaches, and the improvement to my joints was not as was expected. Sometimes it is just the way it is with a switch. Nothing is guaranteed. After months of trying, my rheumatologist and I agreed -it was time for another switch. 

Therapeutic benefit of sulfasalazine appears to be due to a local action of the sulfasalazine and its split product 5-aminosalicylic acid on the mucous membrane and deeper colonic structures.  

Methotrexate is often called the gold standard for the treatment of RA, and I approached it with a mixture of hope and trepidation. The weekly routine of taking those pills became a ritual. Some weeks, I felt stronger, almost normal; other weeks, the side effects – fatigue, mouth sores, stomach upset – reminded me I was far from “normal.” Blood tests became a regular companion, watching for changes in my liver function. And sure, enough, my liver was battered by Methotrexate. Eventually it was realized that the Methotrexate was not aiding my struggle with the effects of Rheumatoid Arthritis.  

Methotrexate (4-amino-10-methylfolic acid) is a folic acid antagonist which inhibits the reduction of folic acid and increase of tissue cells. Methotrexate enters the cell through an active transport mechanism of reduced folates. As a result of polyglutamation of methotrexate caused by the folylpolyglutamylate enzyme, the duration of the cytotoxic effect of the drug substance in the cell increases.  

Adalimumab binds specifically to TNF and neutralizes the biological function of TNF by blocking its interaction with the p55 and p75 cell surface TNF receptors. Adalimumab also modulates biological responses that are induced or regulated by TNF, including changes in the levels of adhesion molecules responsible for leukocyte migration (ELAM-1, VCAM-1, and ICAM-1 with an IC50 of 0.1-0.2 nM). 

Abatacept is a fusion protein that consists of the extracellular domain of human cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) linked to a modified Fc portion of human immunoglobulin G1 (IgG1). Abatacept selectively modulates a key costimulatory signal required for full activation of T lymphocytes expressing CD28. 

I remember the first injection vividly – nervousness and cautious optimism. Actemra’s relief wasn’t permanent. I still have a bucket filled with syringes to show for my brave effort to challenge the symptoms of chronic rheumatoid arthritis!