Biologic treatment provides solution for rheumatoid arthritis patient

Jedidiah Trasadas was no stranger to hard work. Having come from a big family of 14 brothers and sisters, she was working ever since she was young and she continues to work to the present. “I keep myself busy with several things,” she shared.

In addition to running the pawnshop, she also resides alone in the same building as the business while the rest of the family lives outside the city. After turning 50, however, parts of her body began to experience swelling and eventually pain. She has a very high tolerance for pain but as time progressed, the pain began to worsen.

Jedidiah’s symptoms of rheumatoid arthritis (RA) started with a slight swelling in her hands. The swelling was accompanied by itchiness and discomfort but not yet painful. After eight months of on again off again swelling and discomfort, she began to notice that the symptoms started to get worsen. She noticed her ankles as well as her toes beginning to swell too.

“When the pain and swelling had spread to my shoulders, I could not ignore it anymore,” Jedidiah confided. “It was excruciating. A simple touch could cause tremors of pain and it could easily make me cry. It felt like my entire body was swollen.”

With the pain intensifying Jedidiah found she could not even do simple tasks such as sit normally, brush her teeth, or comb her hair. Every movement caused her pain.

At this point, Jedidiah, with the help of her sister, began to seek medical help in the hope of being able to stop the pain.

Partner in treatment plan

It took a while for Jedidiah to find a doctor she was comfortable with. Some of the doctors she saw would not truly take the time out to explain the disease, medication, and treatment plan with her, and she was not satisfied in being a passive participant in her own therapy. Finally she found Dr. Evan Vista, a rheumatologist from UST Hospital, who made her feel like a partner in her treatment plan.

“When I first met Ms Trasadas, she had impaired movements and diffused pain including swelling of the knees which greatly affected her mobility,” Dr. Vista said. “The instant itchiness she mentioned could be qualified more as a discomfort noting that she also presented initially with vasculitic rash on both lower extremities, a variant seen among a subset of RA patients. Her serologic and inflammatory markers were also markedly elevated.”

Dr. Vista initially modified her disease modifying anti-rheumatic drugs (DMARDS) and painkillers, which she had already started taking with the other doctors.

“She had been on methotrexate and prednisone for the pain and swelling, but the overall effect was not as good as we had hoped for,” Dr. Vista said. “She also had to pair these medications with a coxib for the pain. The treatment, as a whole, was not working as we had hoped it would.”

Biologics therapy

“Since we were not getting the results we wanted, Dr. Vista put me on biologics therapy. He explained it might help me get faster and longer lasting results,” Jedidiah said.

With the new treatment plan in place, in February 2011, Dr. Vista began Jedidiah on tocilizumab. Within 2 weeks after infusion, her inflammatory markers dramatically reduced by more than a half and the chronic discomfort she feels eased out. “By the third month of the treatment I started to see the effects of the medication,” Jedidiah shared.

“She responded very well and very quickly to the tocilizumab therapy,” Dr. Vista stated. “She regained her productivity and became a truly functional person once more”

After having cried almost daily for a year prior to the biologics treatment, Jedidiah began to get back to her normal life. She was back at work and she was able to accomplish her daily tasks again.

Jedidiah continued her tocilizumab therapy for six months and though she had an occasional flare up of symptoms once in a while, her overall condition continues to improve.

Through the biologics therapy, Dr. Vista was also able to remove Jedidiah’s steroid use, thereby decreasing the number of medications she had to take.

Jedidiah was told by Dr. Vista that tocilizumab, usually in combination with methotrexate, is indicated for the treatment of moderate to severe active RA in adult patients who have either responded inadequately to, or who were intolerant to, previous therapy with one or more DMARDs) or TNF antagonists—two classes of drugs used to slow down RA progression.

Dr. Vista said tocilizumab is a prescription drug and should only be taken in accordance with the advice of a physician.