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Modern pharmaceutical science has discovered some very potent treatments for autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, plaque psoriasis, lupus, and Sjogren's syndrome.

The more effective a medication is, unfortunately, the more serious its side effects. This is especially true of the medications that modify the immune system to fight an autoimmune process.

 Let's look at the side effects of some of the most common treatments and what can be done about them.

Methotrexate is a medication that has been around since the 1950's. It was actually introduced into mainstream medicine as a less toxic alternative to an even more potent drug. Methotrexate works by interfering with the ability of an enzyme called dihydrofolate reductase to activate the folic acid we get from food into the form cells need for making DNA. This shuts down the ability of a cancer cell or a cell in inflamed tissue in the joints or skin to multiply, and eventually, in theory, healthy cells should take over.

Methotrexate is used to treat rheumatoid arthritis, rheumatoid arthritis, juvenile dermatomyositis, psoriasis, psoriatic arthritis, lupus,sarcoidosis, Crohn's disease, eczema, vasculitis, many forms of cancer, and ectopic pregnancy, as well as to induce abortion. It's a very effective and well-understood drug. The problem, of course, is that shutting down the use of folic acid in sick cells also shuts down its use in healthy cells, and it becomes a game of numbers to hope that the toxic effects of the drug have more effects on the disease than the disabling of healthy cells has on the patient.

The misinformation patients who are on methotrexate get is that they need to take folic acid to restore the vitamin's levels in their cells. Actually, they need to take a slightly different form of the supplement known as methylfolate. This is the form of the vitamin that is activated by the enzyme that is paralyzed by the medication. This isn't something that you should do while you are still on the chemotherapy. It would cancel out its effects. However, it is something that can help you get over side effects far more quickly than simply taking folic acid.

The side effects of methotrexate inspired researchers to look for alternative medications that had fewer side effects. They came up with a different approach to treating autoimmune diseases that stops the inflammation that causes the symptoms, rather than paralyzing DNA production in both healthy and sick cells. One of these medications is etancercept, also known as Enbrel.

Enbrel interferes with the action of an inflammatory substance known as tumor necrosis factor alpha, or TNF-alpha. Blocking the action of TNF-alpha relieves inflammation and tissue destruction in rheumatoid arthritis, juvenile rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and placque psoriasis. Many people notice remarkable changes with minimal side effects. However, when there are side effects, they are likely to be extremely serious.

TNF-alpha causes inflammation and tissue destruction in some diseases, but it also is one of the immune system's most important tools in fighting cancer and infectious disease. Some people have died of systemic infections such as sepsis when they have been on Enbrel. There is an elevated risk of contracting cancer. If you simply cannot bear the pain or disfigurement of the disease, it makes sense to take the drug, but some precautions are in order. Your doctor can stay on the lookout for cancer and sepsis, but there are other conditions that doctors commonly overlook with this medication.

  • Dry mouth caused by the medication can lead to rotting teeth. It's important to be very careful about tooth brushing and getting regular dental checkups (your dentist needs to know you take Enbrel), and it can help to use some of the mouth rinses designed for dry mouth such as ACT, Biotene, and Oasis.
  • Some people become extremely sensitive to beer, coffee, and chocolate when taking Enbrel. They may cause the skin to break out. Unfortunately, if you have to stay on Enbrel, you may have to give up these indulgences.
  • Some people appear to go through personality changes when they are on Enbrel. Usually this is basically a metabolic problem. The medication changes the way the liver metabolizes alcohol, so it has longer-acting effects.

Medications like methotrexate and Enbrel can change your life for the better, if you can handle their side effects. Be forewarned that getting good results may take a little extra effort, but you will have a better quality of life if you can attend to these small precautions.

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