Patient Selection and Safety With TNF Inhibitors - Episode 14
Megan E.B. Clowse, MD: When we think about autoimmune diseases, we really categorize them into a couple of different areas. One is those that come with inflammatory arthritis. The most common one of these is rheumatoid arthritis, but psoriatic arthritis can be an arthritis that comes with psoriasis and ankylosing spondylitis, which is an inflammatory arthritis of the spine, and can also be found in quite a few people. We also think separately about things like lupus or Sjögren syndrome or scleroderma, which can affect the joints but also really affects the internal organs, and so we put those in somewhat of a different category of connective tissue diseases. And then there is another set of autoimmune diseases that are very organ specific. These diseases only hit 1 organ of a patient’s body. For example, thyroid disease is often autoimmune. Inflammatory bowel disease is autoimmune, but it primarily affects the gut.
Many autoimmune diseases are challenging to manage because they are chronic diseases. We don’t really have cures for any of them. We don’t have a medicine that we can give you that will just make the disease go away and stay away forever. Instead, we have medications that manage the symptoms. We try to keep the inflammation as calm as possible, therefore decreasing symptoms as much as possible. But that means that people with autoimmune diseases are often on lifelong medications.
Many patients with autoimmune diseases have other conditions that either go along with them and are sort of a part of their autoimmune disease or can just complicate the whole situation. For example, we see diabetes and high blood pressure in our patients with autoimmune disease, and these patients are at higher risk of having heart disease, strokes, and myocardial infarctions later on in life. We think that actually having the ongoing inflammation of an autoimmune disease compounds and worsens those risks for heart disease in patients who have diabetes and high blood pressure.
In addition, when we look specifically at women who have autoimmune diseases—particularly, women who have rheumatoid arthritis—there appears to be an increase in infertility in this population. Women who have rheumatoid arthritis, as shown for many years, actually tend to have fewer children than women who don’t have rheumatoid arthritis. Some of that is by choice, but a lot of that actually seems to be driven by the fact that they just have a hard time actually getting pregnant.
In order to decrease the risk of having long-term consequences of a comorbid disease, as well as inflammatory arthritis, it’s important to make some key lifestyle changes. For example, maintaining a healthy weight is really important. This can be really challenging when you have inflammatory arthritis and can’t exercise as much as other people can. It can be hard if you are taking a lot of prednisone, which causes weight gain, so working hard to maintain a healthy weight is important. Increasing your exercise is also really important in order to keep your heart and bones healthy. This can also be challenging when you have inflammatory arthritis. It’s not that you want to just go out and exercise every day. It’s really about finding exercises that work for you, that work with your body, that can be adapted to your lifestyle. If one of your risks is bothering you, then the exercise that involves that risk is not for you. If you have a lot of knee problems, then jogging is not going to be appropriate for you. But finding an exercise that you can do regularly is really important.
All of our patients are at high risk of having comorbid conditions when they have inflammatory arthritis. It happens in men, and it happens in women. We see it in everybody. All of our patients really need to be conscious about the lifestyle choices they make, as well as make sure they’re working with all of their regular doctors, their primary care physicians, in order to control all of the other conditions that go along with inflammatory arthritis.