Stelara, or ustekinumab, is a biological drug used to treat adults and children aged six and older with mild to severe plaque psoriasis, adults with moderate-to-severe psoriatic arthritis, and adults with moderate-to-severe Crohn’s disease and ulcerative colitis by reducing inflammation. After previous drugs have failed to work, this one is administered as an injection at home. IL-12 and IL-23, two inflammatory proteins, are blocked by Stelara, but a biological drug like this might take many months to start functioning. Long-term use of biologics is also common.
Stelara is indicated for treating plaque psoriasis and psoriatic arthritis—or both conditions—in adults and children who are at least six years old. Individuals with mild to highly active Crohn’s disease who have failed to respond to prior medications are prescribed Stelara, as are Adults who have moderately to severely active ulcerative colitis.
How to use Stelara
Injections of Stelara are given first, then again four weeks later, and every 12 weeks after that. In Crohn’s disease, it is administered as an injection under the skin, although it may first be administered as an infusion in the vein. Individuals under 100 kg (220 lbs.) get a 45 mg dosage, while those who weigh more than 100 kg receive a 90 mg dose. To lower the chance of infection, you must have a TB screening test before beginning this medicine. While using this drug, patients must see their doctor often for checkups.
Side effects of Stelara
Common Side Effects of Stelara
The common side effects appear when Stelara is injected; at the injection site, there can be bruising, itchiness, discomfort, redness, swelling, or skin hardening.
Reactions at the injection site often subside within one or two days. Back discomfort, sinus/throat pain, or headaches may also occur. Inform your doctor or pharmacist as soon as possible if any of these side effects persist or become worse.
This drug might impact the immune system. Your body’s capacity to fight an infection may be diminished. You may be more prone to severe conditions, like lung infections, bone/joint infections, skin infections, sinus infections, or bowel/gallbladder infections.
Additionally, fighting an illness you already have may be more difficult. If you develop any signs of disease, you must immediately consult your healthcare professional. Symptoms include nausea/vomiting that doesn’t stop, painful/frequent urination, aggravated tenderness and swelling, redness at the injection site after two days, fever/chills, cold/flu symptoms, unusual vaginal discharge, burning, itching, odor, or severe pain in the stomach.
Remember that your doctor has recommended this medicine because they believe it will help you more than harm you—many users of this medicine report no significant adverse effects.
Call your pharmacist and doctor immediately in the case of severe side effects, such as a cough that won’t go away or shortness of breath.
Serious Side Effects of Stelara
Stelara may result in PRES (posterior reversible encephalopathy syndrome), an uncommon (and sometimes deadly) disease. If you get a headache that won’t go away, seizures, abrupt eyesight changes, or mental/mood abnormalities, seek medical attention immediately.
With the use of Stelara, there is a minimal chance that you may get cancer, such as skin cancer. Consult your doctor about the advantages and disadvantages of the proposed course of therapy.
Call your healthcare professional immediately if you have symptoms like strange lumps or growths, unexpected skin changes, swollen glands, or unusual weight loss.
Effect of other drugs on Stelara
Stelara may interact with other medications, such as over-the-counter drugs, prescription drugs, supplements like vitamins, and herbal medicines. Inform your doctor about your existing medications and any new or discontinued ones.
Before starting Stelara, consult your doctor
Stelara could weaken your immune system and raise your chance of developing various infections. Some people using Stelara get severe infections like tuberculosis (TB) and infections brought on by bacteria, fungi, or viruses, which may need hospitalization.
Before beginning the Stelara medication, your doctor should test you for TB. They should also keep a careful eye out for any TB symptoms while you are on Stelara.
If your doctor believes you are at risk of TB, you could get TB therapy before and after taking Stelara.
If you are suffering from any infection, you must not take Stelara until your doctor gives the all-clear.
Before initiating Stelara, you must consult with your doctor if you have the following symptoms:
Red or painful skin
Shortness of breath
Blood in phlegm
Stomach pain or diarrhea
Warnings and precautions for Stelara
Never start Stelara when there is a clinically significant active infection. Consider stopping Stelara until the infection clears up if a major infection or clinically significant infection develops.
Theoretical Risk of Specific Infections:
Patients with hereditary IL-12/IL-23 deficiency have been linked to severe infections from mycobacteria, salmonella, and BCG vaccines. Consider diagnostic testing for these infections as warranted by the clinical situation. Before beginning Stelara medication, people with tuberculosis (TB) should be tested for the disease. Before giving Stelara, begin latent TB therapy.
The chances of cancer development increase with the use of Stelara. Its safety in individuals with a history of or currently being treated for malignancy has not been examined.
Anaphylaxis or other clinically severe hypersensitivity events might happen.
If you suspect PRES, get treatment at once and stop taking Stelara.
During post-approval use of Stelara, cases of interstitial pneumonia, eosinophilic pneumonia, and cryptogenic organizing pneumonia have been reported. If the diagnosis is validated, stop taking Stelara and start the appropriate therapy.
What is a Copay Accumulator?
A copay accumulator, also known as an accumulator adjustment scheme, is used to prevent manufacturer copay assistance coupons used by insurance companies and pharmacy benefit managers (PBMs) from being utilized to cover two prices:
the maximum amount you must pay out of pocket.
Pharmaceutical firms try to develop programs to cover patients’ out-of-pocket expenses. Some payers diminish the value of these programs by using up the funds allotted for them while also needing patients to cover their deductibles and co-insurance costs up to their out-of-pocket costs to get their medications.
Use of Copay Accumulator Program
A copay accumulator program alters the way an insurance provider administers and accounts for payments made, using a copay card from a prescription manufacturer. The copay card’s contributions often cover your deductible and other out-of-pocket expenses. It may protect you from having to pay considerable amounts out of pocket each year when you take a costly specialty drug, such as a biologic.
Although accepted at the pharmacy, the copay card’s contributions will no longer be used to cover your deductible and other out-of-pocket expenses if your insurance provider starts using an accumulator program. Instead, any payments made with your copay card will be sent directly to your health insurance provider, and not deducted from your deductible, or applied to your out-of-pocket expenses.
The copay accumulator program transforms the possible out-of-pocket expenses from $0 to now completely covering the deductible, followed by any co-insurance or co-pay amounts. You are left to bear the bill when your copay card expires and therefore make no progress toward meeting your yearly deductible.
People sometimes don’t notice the change until the copay card’s remaining balance is reached. They don’t realize their deductible and out-of-pocket limit have remained unchanged until this occurs. They must immediately begin paying down any applicable deductibles and co-insurance/copays until they have reached the plan’s out-of-pocket limit.
How to Address Copay Accumulators
Prepare for a surge in copay accumulator plans by anticipating it.
The benefit inquiry process extensively examines the patient’s plan to find any that contain an accumulator adjustment program.
Educate people when you notice they are enrolled in plans with an accumulator adjustment scheme.
Talk to patients about how a specialty drug may affect their insurance and how their financial obligations may change throughout their therapy.
Working on a Copay Accumulator Program
In the past, a person may have obtained financial aid from a medication manufacturer, and relying on the insurance plan, would have contributed against their deductible and out-of-pocket expenses. Pharmaceutical firms would often provide financial assistance to those with inadequate insurance in order to pay for pricey prescriptions. The individual purchasing the medication would ultimately save money—sometimes hundreds of dollars.
Where ASCO Stands on Copay Accumulators
According to ASCO’s Position Statement on Copay Accumulators and Copay Maximizers, the use of copay accumulator adjustment and copay maximizer programs for cancer patients is unacceptable. The statement also offers the following suggestions:
To further protect patients, federal and state governments should pass legislation that forbids copay accumulator adjustments and copay maximizer programs.
The Centers for Medicare and Medicaid Services (CMS) should outlaw the use of copay accumulator adjustments in the programs they administer and regulate.
Commercial insurers and PBMs should immediately stop using these programs.
Public and private insurers and PBMs should, at the very least, guarantee openness by outlining the copay accumulator adjustment program’s structure for users, as needed by the Centers for Medicare and Medicaid Services Summary of Benefits and Coverage Instruction Guide.
Copay Accumulator as an Evolving Policy
The use of copay accumulator and maximizer programs is growing, and recent legislative changes made via federal regulation and state legislation have raised additional questions about the future of the program and the interests of the organizations they touch.
The use of copay adjustment schemes, such as copay accumulator and maximizer programs, by payers and pharmacy benefit managers (PBMs) to reduce plan sponsor exposure to specialty prescription prices has increased in recent years. Although both programs utilize distinct tactics, they aim to use manufacturer copay assistance while keeping those funds from contributing to a patient’s commercial insurance deductible and maximum out-of-pocket limit.
According to a recent review of commercial insurers, 83% of participants are in plans with copay accumulator schemes, while 73% are in plans with copay maximizer programs. According to the data, 26% of the cost adjustment programs were for medical benefit goods, and 77% were for pharmacy benefit products. For payers, manufacturers, and patients, accumulators and maximizers provide new problems and issues. Since these programs are anticipated to expand in the ensuing years, recent regulatory and legislative action at both federal and state levels raises further concerns.
Implementation by Insurance Companies
Insurance providers and PBMs that have reportedly begun implementing these initiatives include:
Cigna Blue Cross Blue Shield
Various insurance providers and PBMs may use differing terminology for these programs. The one from Express Script is referred to as the “Out of Pocket Protection Program,” whereas United Healthcare refers to it as the “Coupon Adjustment/Benefits Plan Protection Program.”
The infusion-related reaction is characterized by an adverse response to the infusion of pharmacological or biological substances.
A drug that releases cytokines may produce an acute infusion reaction. Within 24 hours after the end of the medication infusion, signs and symptoms often stop developing. The common reactions due to infusion include lethargy, malaise, allergic reaction/hypersensitivity, arthralgia (joint pain), bronchospasm, cough, dizziness, dyspnea, fatigue, headache, hypertension, hypotension, myalgia (muscle pain), and nausea. Rigors and chills; Rash and desquamation; Pruritis and itching; Sweating; Tachycardia, urticaria, and vomiting.
Infusion or acute infusion reactions, like anaphylactic reactions, may happen during or shortly after the infusion. Patients must carefully identify the symptoms to classify them as an “infusion-related response” and distinguish between the phrases “infusion reaction” and “anaphylaxis.” Infusion reactions often refer to symptoms that appear shortly after receiving an infusion and are not always associated with hypersensitivity or anaphylaxis.
The common terms for infusion-related reactions include anaphylaxis, anaphylactoid responses, and cytokine release syndrome, which are frequent with monoclonal antibodies (mAbs) and promptly tied to drug delivery.
Common Signs of Infusion Reactions
The following are the common symptoms of infusion reactions.
Swelling of eyelids, tongue, lips
Respiratory issues, like shortness of breath
Notify your healthcare provider or infusion nurse as soon as possible if you notice any of the symptoms mentioned above while receiving an infusion. After your infusion, notify your healthcare team immediately if you experience these symptoms at home.
When to Call Healthcare Provider?
The doctor or team of medical professionals supervising your treatment will also monitor your vital signs, look for any infections that may still be active, and ask about your general health.
You must call a professional and highly skilled healthcare provider to handle any infusion reactions in case of an infusion reaction so they may stop or lower your infusion rate.
Your medical staff will keep a careful eye on you throughout the entire process.
It’s critical to contact your healthcare professional immediately if you experience any signs or symptoms up to 24 hours after your infusion.
When to Call 911?
One of the most common infusion reactions is a severe allergic attack called anaphylaxis that must be treated on a priority basis. If you have an anaphylactic shock, your healthcare provider will inject epinephrine (adrenaline) immediately. In case of severe reactions, dial 911 for immediate medical assistance. It may be fatal if neglected.
You must ask for emergency assistance if the person exhibits respiratory problems or lack of circulation symptoms. Call 911 if you know the person is affected by the infusion reaction or any symptoms.
It’s critical to remember that epinephrine passes over time. In such a panicked situation, you must need emergency care, even after receiving an injection; as soon as you administer the epinephrine, dial 911 or immediately arrange a trip to the hospital.
Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune ailment with inflammatory characteristics, and which affects the central nervous system (CNS). It manifests as optic neuritis, myelitis, and brain lesions. Relapses or attacks occur in patients with this fatal condition at intervals of weeks, months, or years, followed by remissions.
Managing Fatigue and Loss of Vision in NMOSD
Relaxation (or rest) is a crucial component of the overall therapy strategy for individuals with NMOSD, as well as exercise to maintain a sufficient fitness level. NMOSD sufferers often experience fatigue, which has been linked to poor sleep, pain, and sadness. It may be helpful to manage energy utilization while carrying out everyday tasks to lessen weariness. Maintaining energy levels may be achieved by setting priorities and completing the most important activities first thing in the morning. Exhaustion can be minimized by striking a balance between sleeping and doing your daily business.
NMOSD’s visual impairment may greatly impact the quality of life. Patients may be able to continue their daily routine using technology like voice-activated software and tactile devices.
Managing Pain and Diet in NMOSD
The problem of chronic pain in patients with NMOSD may last a lifetime. Although it might start in particular locations on the body, pain typically spreads over the whole body. The mental anguish of the patient might be made worse by persistent pain. Patients try to handle the impact of pain on their everyday tasks with the assistance of a medical team that consists of physiotherapists, pain doctors, nurses, and psychologists.
The arms and legs of the patients with NMOSD may become weakened, numb, or paralyzed during an NMO flare-up. Moving, working, or everyday tasks may be more challenging. To assist you in improving your arm and leg function, your doctor can recommend physical or occupational therapy.
Therapists may show you how to utilize aids like canes and walkers. Additionally, they may design specialized physical treatment regimens to strengthen and stabilize problem regions.
If an NMOSD patient wants to feel better, he can do the following things.
Yoga: It reduces pain, keeps you flexible, enhances mood, promotes better sleep, and relaxes the body.
Exercise: It can help overcome bowel and bladder problems, boost energy, helps with depression and fatigue, and promotes better sleep. Before starting any exercise routine, you must consult with your doctor.
Living With Vision Problems
Your spinal cord and optic nerves are most impacted by NMO, also known as Devic’s disease or NMOSD. Your eyes communicate with your brain via optic nerves. NMO damage may result in issues like:
Loss of vision
Difficulty in seeing colors in the dark
NMOSD may sometimes result in spasticity, a painful disease marked by stiffness and muscular spasms. To maintain your flexibility and enhance your mobility, a physical therapist may give you exercises to do, and you need to use splints, a sort of brace.
The treatment of NMOSD-related spasticity can be by:
Botulinum toxin injections: often called Botox; it relaxes your muscles. The results persist for many months. If just a few of your muscles are spastic, it will work well for you.
Serial casting: This treatment holds your ankle, wrist, or elbow joints in positions that gradually increase joint mobility using a succession of casts.
Bowel and Bladder Control
Living with NMOSD is very difficult. One problem is bladder and bowel control. Your bowel and bladder function may suffer if NMO damages your spinal cord. Constipation is common. You may have incontinence (problems regulating your urine and intestines), or urgently need to use the restroom. Your signs may improve if you:
Do regular exercise
Consume a fiber-rich diet
Drink lots of water
Do not eat citrus fruits, including tomatoes, and acidic foods; also avoid caffeine.
Causes of NMOSD
The clinical condition of NMOSD has been linked to two distinct antibodies. An assault on the aquaporin-4 (AQP4) water channel, found in the optic neurons and spinal cord, is the most frequent cause in the adult population. Proteins called aquaporins (AQPs) move water across cell membranes. An antibody biomarker termed the NMO-IgG is detected in the blood of almost 70% of people with NMOSD (anti-AQP4 antibody). More than half of all NMOSD with pediatric-onset is caused by autoantibodies against myelin oligodendrocyte glycoprotein (MOG), which is present in up to one-third of NMOSD patients who test negative for antiAQP4 antibodies.
Treatment of NMOSD with SOLIRIS
The FDA-approved drug for individuals with neuromyelitis optica spectrum disorder (NMOSD) is SOLIRIS (eculizumab). The patients of NMOSD are anti-aquaporin-4 (AQP4) antibody-sensitive. Data about the safety of SOLIRIS is not available for children with NMOSD.
Mechanism of action of SOLIRIS
In contrast to conventional multiple sclerosis lesions, NMOSD lesions exhibit substantial complement activation, eosinophilic infiltration, and vascular fibrosis. The primary humoral immune system-mediated attack on AQP4 is the pathophysiology of NMOSD. A humanized monoclonal antibody called eculizumab blocks the terminal complement protein C5 from cleaving into C5a and C5b. Although the precise mechanism for its effectiveness in NMOSD is unknown, it is thought to be connected to the prevention of the membrane assault complex’s development, which is mediated by C5b.
The Clinical Indication for SOLIRIS
Eculizumab, or Soliris, was the first medication approved by the FDA for treating adults with anti-aquaporin-4 (AQP4) antibody-positive NMOSD.
Previously, the FDA had approved Soliris for the treatment of the following conditions.
It is advised to administer SOLIRIS intravenously once per week for the first four weeks, followed by the fifth dose one week later and then every two weeks.
Common Side Effects of SOLIRIS
Severe allergic reaction from SOLIRIS is the most common side effect.
What is Plaque Psoriasis?
The most prevalent type of psoriasis is plaque, which results in dry, raised skin patches (plaques) coated in grey or silver scales. Based on skin tone, it may appear differently, ranging from pink on white skin to dark or grey on brown or Black skin.
Causes of Plaque Psoriasis
Medical experts are uncertain about the causes of plaque psoriasis. It is regarded as an autoimmune condition in which your immune system considers healthy cells as if they were infected. Because of this, new skin cells develop considerably more quickly than usual and accumulate in dense regions.
How Is Plaque Psoriasis Diagnosed?
Plaque psoriasis is classified as mild, moderate, or severe depending on the area and intensity of the plaques, the proportion of skin affected, and other factors.
Plaques may manifest as scalp psoriasis or genital psoriasis. However, they often appear on the hands, feet, elbows, knees, and back.
What is Skyrizi?
In April 2019, the FDA authorized Skyrizi (its generic name is risankizumab-rzaa) and is indicated for managing moderate-to-severe plaque psoriasis in adults. Moreover, in January 2022, the FDA approved Skyrizi for treating adult patients with active psoriatic arthritis (PsA).
Your doctor could advise you to take Skyrizi if you have plaque psoriasis. It is indicated for patients whose condition might benefit from systemic medicines or light therapy, as your entire body is affected by systemic treatment.
After two beginning doses, the SKYRIZI therapy may help you maintain smoother skin with four doses annually. Three out of four participants in clinical studies had 90% clearer skin after four months (16 weeks). Nearly 90% of those who had a 90% improvement in skin clarity maintained it for a full year. In clinical studies, many participants with plaque psoriasis saw clearer skin after a year.
Mechanism of Action of Skyrizi
Skyrizi (risankizumab-rzaa) is a humanized immunoglobulin G1 (IgG1) monoclonal antibody and an Interleukin-23 antagonist. It specifically binds to the human interleukin 23 (IL-23) cytokine’s p19 subunit and prevents it from interacting with the IL-23 receptor. A naturally occurring cytokine called IL-23 has a role in inflammatory and immunological reactions. The release of cytokines and chemokines that promote inflammation is inhibited by risankizumab-rzaa.
How to take Skyrizi?
The method to take Skyrizi will be explained to you by your health care professional. They’ll also go through the dose you need and how often to take it. Adherence to your doctor’s recommendations and following your doctor’s instructions for doses is essential.
Skyrizi is injected beneath the skin and comes as a solution within single-dose prefilled syringes. Your doctor will probably administer your first several Skyrizi dosages. You may begin administering Skyrizi injections to yourself at home after your first few doses. Your doctor will show you how to do it. For further details on administering Skyrizi by yourself, you can also check out the manufacturer’s website.
At the starting week of treatment (week 0), Skyrizi is administered through injection under the skin, then again on week 4, and then every 12 weeks after that.
Sickle cell disease manifests as a genetic blood condition known as sickle cell anemia. The change in the red blood cells usually observed forms when you have sickle cell anemia, going from being round, flexible discs to rigid, sticky sickle cells that obstruct blood flow. About half of those with sickle cell anemia survive into their 50s through early identification and the latest therapies.
Compared with healthy red blood cells, sickle cells have a shorter lifespan. Anemia is called sickle cell anemia since a patient doesn’t produce enough healthy red blood cells.
Children born with sickle cell disease hardly ever make it to adulthood. Nearly half of those with sickle cell anemia now reach their 50s owing to early identification and modern therapies. Sickle cell anemia patients continue to remain at risk for possibly fatal medical issues. Furthermore, medical professionals have procedures that lessen the likelihood of problems and soothe symptoms. Still, no appropriate medical therapy for sickle cell disease is accessible in many parts of the world.
Symptoms of Sickle Cell Disease
The symptoms of sickle cell disease often appear in newborns around the age of five months. Each person’s symptoms are unique and evolve gradually. The following are the symptoms of SCD.
Sickle cells are more delicate than normal red blood cells and often disappear or die after 10 to 20 days. Almost 120 days is the average cell life span in this way. This leads to the loss of red blood cells, called anemia.
Fatigue results from a lack of red blood cells because it affects the transport of oxygen throughout the body.
Pain attacks are a common sign of sickle cell disease. Pain in your chest, belly, joints, and bones is brought on by red blood cells with a sclerotic form that obstructs blood flow via small blood arteries. The pain’s level and frequency might change, and sometimes, you might need to visit the hospital.
Hands and feet swelling:
Swelling results from sickle-shaped red blood cells obstructing blood flow to the hands and feet.
Risk of infections:
Ulcers may develop when sickle cells harm your tissues. Also, it’s possible you might get infections if they affect your spleen. Healthcare professionals usually give SCD patients immunizations and medications to avoid potentially harmful infections.
Jaundice or Yellowing of Skin and eyes:
It may happen due to damaged sickle RBCs.
Sickle cells may get lodged in the blood arteries that nourish your eyes, negatively affecting your retina and impairing your eyesight.
Children with SCD may develop more slowly than other kids. Teenagers affected by SCD may reach puberty later than similar-aged teenagers.
One more severe and unexpected consequence affecting sickle cell patients is the chance of a stroke. The damaged cells might block the main blood arteries that provide oxygen to the brain. Severe brain injury may occur if the blood and oxygen supply to the brain is eliminated. A stroke caused by sickle cell anemia increases your chance of a second and third stroke.
Treatment of Sickle Cell Disease
Hydroxyurea (Droxia, Hydrea, Siklos)
Using daily hydroxyurea lowers the incidence of painful crises and may lessen the requirement for hospitalization and blood transfusions. However, it could enhance the chances of infections. If you are pregnant, avoid using the medication.
L-glutamine oral powder (Endari)
This drug recently got approval from the FDA to treat sickle cell anemia. The likelihood of pain can be minimized by using this drug.
Adults and children over 12 may take this drug to treat sickle cell disease. This medication, when taken orally, may increase blood flow throughout the body and reduce the risk of anemia. The possible adverse effects are headache, nausea, diarrhea, exhaustion, rash, and fever.
For sickle cell-related pain issues, your doctor may also prescribe narcotic analgesics (painkillers) to reduce pain severity.
What is Adakveo?
Adakveo is a brand-name prescription drug called Crizanlizumab. This drug is FDA to avoid vaso-occlusive crisis (VOC) in adults and children 16 years of age and older with sickle cell disease. VOC is another name for a pain crisis.
The hereditary disorder sickle cell disease alters the structure of your red blood cells. Most often, sickle cell disease is discovered in newborns.
Few individuals with sickle cell disease have a pain crisis. Pain crises often result in intense pain. Additionally, this may result in a blood clot, raising the danger of organ damage and stroke.
Administration of Adakveo
Adakveo is administered as an intravenous (IV) infusion into your arm—it is a liquid solution. (An infusion is an injection that is slowly injected into your vein.) The dosage of the drug is 100 milligrams of the drug per 10 milliliters of solution.
Adakveo may be administered in an infusion suite, a medical facility designed exclusively for infusions. It can also be given to doctor’s clinics and hospitals. Rarely, a nurse may be able to provide the infusion to you at home.
Adakveo is a member of the class of drugs known as selectin blockers. Crizanlizumab is the active ingredient of Adakveo.
FDA approval of Adakveo
In November 2019, the Food and Drug Administration (FDA) authorized and approved Adakveo. The first targeted therapy for a pain emergency is adakveo. This indicates that it functions differently from other pain relief drugs. Adakveo identifies blood cells and prevents blood clots as opposed to alleviating the pain.
Important Adverse Reactions of Adakveo
Some adverse effects include nausea, joint discomfort, back pain, and fever. Fewer than 10% of patients receiving ADAKVEO noted clinically significant adverse effects such as oropharyngeal pain, infusion site reaction, diarrhea, vomiting, pruritus (including vulvovaginal pruritus), musculoskeletal chest pain, and myalgia.
Gout is arthritis that affects the joints and produces severe pain, swelling, and stiffness. The metatarsophalangeal joint is primarily affected by gout at the base of the big toe. The primary reason is accumulating a high amount of uric acid in the body.
The most prevalent inflammatory arthritis in men is gout, affecting over 3 million Americans. Females are more prone to gout after menopause, even though the disease affects them less.
Gout episodes may strike suddenly and may repeat over time. This continuous recurrence may cause tissue damage at the inflammation site over time and can be extremely painful. Gout is caused by high blood pressure, cardiovascular disease, and obesity.
Some people have only acute gout episodes once or twice a year (or even 1-2 times in a lifetime). Gout may, however, be a chronic, recurring condition for certain people, with several acute symptoms occurring at short intervals and no full clearance of inflammation between attacks.
This gout, known as chronic gout, may lead to the destruction of joints and deformity and may be misinterpreted as chronic inflammatory arthritis, including rheumatoid arthritis.
Uric acid tophi (hard, uric acid deposits beneath the skin) are common and contribute to the deterioration of bone and cartilage. Tophi diagnose chronic tophaceous gout. Tophi may be present in the olecranon bursa, the olecranon bursa, or the ear’s pinna. Finally, tophi may be dissolved with therapy and will eventually dissolve.
Chronic tophaceous gout is the most devastating gout and may cause irreversible joint and kidney impairment. Individuals with chronic arthritis and tophi in colder parts of the body, like the joints of the fingers, might develop tophi at this stage.
After several years of acute gout episodes, chronic tophaceous gout develops. But, individuals who get good therapy are unlikely to reach this level.
Symptoms of Chronic Gout
What follows are the signs and symptoms of chronic gout that may occur suddenly, especially at night.
Intense Joint Pain.
Gout is often concerned with the big toe, although it may affect any joint. The other joints typically afflicted are ankles, knees, elbows, wrists, and fingers. The pain will likely be the worst during the first four to twelve hours after it starts.
Some joint soreness may remain from a few days to a few weeks after the most acute pain has subsided. Episodes are more likely to continue longer and damage more joints.
Presence of Inflammation and redness.
Swollen, sensitive, heated, and redness develop in the afflicted joint or joints.
Limited range of motion.
Your movement may become restricted with chronic gout’s intense pain and discomfort.
Medical therapy and self-management measures may treat and control gout. Your health care physician may recommend a medical treatment strategy to manage gout-related pain.
Nonsteroidal anti-inflammatory medicines (NSAIDs), including ibuprofen, steroids, and the anti-inflammatory drug colchicine, are used to treat flares.
Making dietary and lifestyle adjustments to avoid future flare-ups, including decreasing weight, restricting alcohol, and eating fewer purine-rich foods (such as red meat or organ meat), may help prevent recurring attacks.
Changing or quitting hyperuricemia drugs (such as diuretics) may also assist.
Tophi and kidney stones may result from chronically elevated uric acid levels. Tophi are uric acid deposits beneath the skin that are hard and painful.
Preventive treatment to decrease uric acid levels in the blood with medications like allopurinol, febuxostat, and pegloticase may be recommended for those with recurrent acute flares or chronic gout.
Chronic Gout and KRYTEXXA
Chronic gout treatment is now possible with KRYSTEXXA, which works by changing uric acid into a water-soluble substance known as allantoin. It can be removed through urine from the body. Some have observed that administering only one IV dose of KRYSTEXXA lowers uric acid levels—it does this by dissolving them. It is possible to clear uric acid crystal build-ups that were deposited many years ago.
KRYSTEXXA is the only FDA-approved medicine to treat chronic gout. For more than ten years, it has been the only drug used by the patients to control chronic gout otherwise not controlled or treated by other medicines. According to research studies, the results can be seen with 1 IV treatment every other week for almost six months.
Important information you should know about KRYSTEXXA?
Sometimes, individuals who get KRYSTEXXA may experience severe allergic reactions. These allergic reactions can be fatal and usually occur within two hours after receiving the infusion.
A doctor or nurse should only administer KRYSTEXXA in a facility where severe allergic reactions can be managed. During and after your treatment with KRYSTEXXA, your doctor or nurse should watch for any signs of a significant allergic response.
Administration and Dosage:
KRYSTEXXA is administered via intravenous infusion bi-weekly.
Common Side Effects of KRYSTEXXA. :
The following are the common side effects of KRYSTEXXA.
Fast or weak heartbeat
Swelling of tongue or throat
Shortness of breath
Precautions for KRYSTEXXA.
Before you receive KRYSTEXXA, tell your doctor if you:
If the doctor prescribes you KRYSTEXXA, tell your doctor if you:
If you have a known deficiency of G6PD .
If you have suffered from or currently have high blood pressure and heart problems.
In cases where a female is pregnant or wants to become pregnant; it is unknown whether KRYSTEXXA will harm your unborn baby.
If you are breastfeeding or plan to breastfeed, it is unknown if KRYSTEXXA affects your child if it passes into breast milk.
Make a list of all your medications and provide it to your doctor. While taking KRYSTEXXA, take no other uric acid-lowering medication, including allopurinol or febuxostat.
Your doctor may prescribe medicine to help you avoid a reaction before you begin treatment with KRYSTEXXA. Follow the instructions of your doctor or nurse for taking these medications. To monitor your response to KRYSTEXXA, your doctor will test your uric acid levels before each session.
Unfortunately, plaque psoriasis is a lifelong condition. However, there are ways to control flare ups and reduce painful, debilitating symptoms.
Managing your plaque psoriasis depends on a few things such as how much skin is affected, how bad the disease is, and the location. Your dermatologist or family physician will be able to help develop a treatment plan that works best for you.
Always consult with your dermatologist or family doctor before trying these treatments.
Skincare for plaque psoriasis
What you put on your skin plays a significant role in getting your plaque psoriasis under control while relieving symptoms. Look for hypoallergenic, alcohol-free, dye-free, and fragrance-free products when it comes to plaque psoriasis moisturizers and soaps.
Some skincare products to consider for your plaque psoriasis are:
When looking at your diet, stay away from foods that cause inflammation, like alcohol, dairy, refined carbs, gluten, added sugar, saturated fats, and trans fats. Replace with foods that are rich in vitamins, minerals, and antioxidants, like:
omega-3 fatty acids – salmon, shellfish, walnuts, and soybeans
fruits and vegetables – leafy greens, berries, and pineapple
healthy fats – avocado, olives, olive oil, and coconut oil
high-quality protein – beans, lentils, nuts, cage-free eggs, tuna
Topical prescription medications
If over-the-counter creams aren’t working, your dermatologist may recommend a prescription medication that goes directly on your skin to help with inflammation and delay skin cell growth.
PUVA– Ultraviolet A (UVA) light with the medication, psoralen
Systemic treatments are prescription medications that work throughout the body for moderate to severe cases of plaque psoriasis. They are also used if you don’t respond well to phototherapy or topical creams.
There are two types of systemic treatment: non-biological (tablets or capsules) and biologic (injections or IV infusions).
Understanding (and avoiding) triggers, sticking to a psoriasis-friendly skincare routine, creating a healthy lifestyle, and taking medications when needed, can help you manage your plaque psoriasis and improve your quality of life.
If you feel depressed or overwhelmed, there are resources available online and in your community to offer support and strategies for coping. Talk to your doctor or visit the below websites for more information.
Managing your plaque psoriasis requires an individualized treatment plan that includes medication, lifestyle changes, and mental health care. Specialty Infusion Centers collaborate with your specialist to provide infusion therapy based on your predetermined treatment plan.
Our centers offer private suites, amenities, and flexible evening and weekend appointments. All you have to focus on is feeling better! Reach us to learn more or get started today!
Ocrevus, which is the generic name for the pharmaceutical drug, Ocrelizumab, is prescribed to treat relapsing types of multiple sclerosis (MS), such as clinically isolated syndrome, illness, and active secondary progressive disease in individuals with primary progressive MS.
Ocrevus uses a therapeutic monoclonal antibody that takes a novel approach to treat multiple sclerosis. It targets CD20-positive B cells, a type of immune cell that plays a critical role in the disease. The FDA has approved Ocrevus to treat relapsing or primary progressive multiple sclerosis (MS). Ocrevus is administered as an intravenous (IV) infusion once every six months.
Who can take Ocrevus?
Individuals with active relapsing-remitting MS and highly active relapsing-remitting MS who are unable to take Lemtrada may be given Ocrevus.
Contraindications of Ocrevus:
Consult your doctor about any current medications you are taking or underlying illnesses you already have to ensure that this drug will be right for you. If you have severe illnesses such as cancer or serious infections like HIV/AIDS or hepatitis B, you may not be a good candidate for the medication.
Conception and pregnancy:
While you are being treated with Ocrevus, it is advised to abstain from pregnancy. If you are planning for a baby, consult your health care provider for advice concerning your personal situation. During treatment and for 12 months after stopping Ocrevus, women of childbearing age must use a form of contraception.
Administration and Dosage of Ocrevus:
Ocrevus is administered as a biweekly intravenous infusion for two doses, followed by a maintenance dosage for six months.
Common Side Effects of Ocrevus:
Infections and reactions to infusions are common side effects of Ocrevus.
Tysabri, the generic brand name for the pharmaceutical drug natalizumab is a medication used to treat patients with relapsing forms of MS. It can reduce the frequency of flare-ups and help prevent physical limitations as a result of the disease from rapidly worsening.
The mechanism of Tysbari is different from other multiple sclerosis medications. It prevents white blood cells in the immune system from accessing the brain and spinal cord, which scientists believe plays a key part in the progression of MS’s debilitating symptoms.
The FDA has approved Tysabri as a monotherapy (not to be used in conjunction with other disease-modifying medicines) for the treatment of relapsing types of multiple sclerosis, such as clinically isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease (ASPD) (SPMS with relapses).
Administration and Dosage:
Tysabri is administered every four weeks through intravenous infusions.
Common Side Effects:
Adverse side effects of Tysabri include liver dysfunction, allergic reactions, a compromised immune system and low platelet counts. Tysabri may also cause complications if you have certain forms of herpes, leading to severe and possibly fatal, herpes infections. Call your doctor right away if you experience any herpes infections.
Other side effects of the drug include headache, fatigue, urinary tract infections, joint pain, lung infections, depression, pain in the arms or legs, diarrhea, and vaginitis. Rash, nose and throat infections, nausea, and stomach discomfort are all symptoms of a urinary tract infection. Consult your healthcare provider if any side effects you experience worsen in severity or persist for a long period of time.
Difference between Ocrevus Vs Tysabri
Monoclonal antibodies such as Ocrevus (ocrelizumab) injection and Tysabri (natalizumab) are used to treat relapse types of multiple sclerosis (MS).
Ocrevus is also used to treat primary progressive multiple sclerosis (MS).
In adults, Tysabri is prescribed to treat moderate to severe Crohn’s disease. Tysabri is frequently used when previous Crohn’s disease drugs have failed to treat the illness effectively. Monoclonal antibodies like Ocrevus and Tysabri are two different kinds. Tysabri is a recombinant humanised IgG4, a monoclonal antibody, and Ocrevus, a CD20-directed cytolytic antibody.
Depression is a common side effect of both Ocrevus and Tysabri. Infections like upper and lower respiratory tract infections, infusion reactions (such as itching, rash, hives, redness, bronchospasm, throat irritation and swelling, mouth pain, shortness of breath, flushing, hypotension, fever, fatigue, headache, dizziness, nausea, and fast heart rate), skin problems, backache, and pain in the legs and feet are all side effects of Ocrevus that do not occur with Tysabri.
Headache, tiredness, joint or muscle pain, redness or irritation at the injection site, swelling hands/feet/ankles, changes in the menstrual cycle, painful menstrual cramps, stomach pain, diarrhea, skin rash, and cold symptoms such as stuffy nose, sneezing, or sore throat are all side effects of Tysabri.
Both Ocrevus and Tysabri have the potential to interact with other immune-modulating or immunosuppressive medicines, such as immunosuppressive corticosteroids, chemotherapy, or radiation.
What drugs interact with Ocrevus?
Interaction of Ocrevus can occur when it is taken in combination with other immunosuppressive agents and immune-modulating therapies such as immunosuppressant doses of corticosteroids. It is essential to consult your doctor about all the supplements and medications you are currently using to prevent any drug complications,
What drugs interact with Tysabri?
Interactions of Tysabri can occur when it is taken in combination with medicines that may affect the immune system like sirolimus, interferon cyclosporine, azathioprine, tacrolimus, mofetil, muromonab-CD3, leflunomide, basiliximab, etanercept, radiation treatment and chemotherapy.
How should Ocrevus be taken?
Before starting Ocrevus, you must undergo a hepatitis B virus test. Before each infusion, take methylprednisolone (or a comparable corticosteroid) and an antihistamine. The initial dose of Ocrevus is a 300 mg intravenous infusion, followed by a second 300 mg intravenous infusion two weeks later, and a 600 mg intravenous infusion every six months after that.
How should Tysabri be taken?
300mg is the suggested dose of Tysabri for Crohn’s disease and multiple sclerosis through intravenous infusion over one hour every four weeks.