In one of the articles from this week, we read about how various cytokines have key roles in the pathogenesis of rheumatoid arthritis (RA). I wanted to find out more about TNF inhibitors because they seem to have become a standard treatment for RA patients. I came across this article, which covers the potential role of these therapeutics in the development of certain cancers in patients who were treated with TNFα inhibitors. These are patients who were diagnosed with chronic immune-mediated diseases, including those with rheumatoid arthritis.
The researchers aimed to find a correlation (or lack thereof) between cancer risk and TNFα inhibition therapy. They conducted a Safety Assessment of Biological Therapeutics (SABER) study to comparatively analyze the safety of TNFα inhibitors to alternative treatment strategies. Recently, there have been many studies suggesting the malignancy of TNF inhibitors and the detrimental health risks they can induce in RA patients. This article covers a different stance in that the researchers conclude that short-term cancer risk is not increased in RA patients treated with TNFα inhibitors compared to other commonly used therapies for chronic inflammatory diseases.
Previous studies have produced divided conclusions, some stating that the incidence of cancer did indeed increase in TNFα-inhibitor treated RA patients and others arguing that no solid cancers were seen in among RA patients treated with these inhibitors. One thing these studies have in common is that they all focused on only TNFα inhibitors and compared the incidence of cancer in RA patients treated with TNFα inhibitors to those who were not treated. The article above brings something new to the table, suggesting that comparing other drugs to TNFα inhibitors will provide more information to physicians and clinicians about which treatments should be favored with RA patients. The researchers are not hypothesizing whether or not TNFα inhibitors directly increase the incidence of cancer in RA patients. They realize that this form of therapy could very well result in some health risks, but the greater goal was to find out if these inhibitors create more harm than their counterparts (similar drugs). And as seen in the findings, this was not the case.
With that said, is it fair to say that TNF inhibitors are causing an increased incidence of cancer in RA patients when alternative treatments are just as risky (if not riskier) but less effective? Would you be willing to possibly risk causing harm to other parts of your body in order relieve the agonizing pain from arthritis? Will we be able to find a treatment that will not make us choose between one illness and another, or is this unavoidable?
Here is another recent article from a general interest news source on the newer RA drugs to stimulate your brain.
This idea of treating one disease, yet increasing your risk of another disease is definitely something that has to be a personal decision. Personally, I don't have any kind of arthritis so I can't say anything from my own experiences and how I would fare if I did have it. People who actually suffer from it though, I think their treatments plans would have to be based on the severity degree of their rheumatoid arthritis.
ReplyDeleteThese studies on TNF alpha just tell me how uncertain, and dangerous, altering our body chemistry can be. TNF is something that is finely regulated to induce apoptosis in our bodily systems; when we have a disorder that alters this regulation, it would seem like a good idea to block it. But what we forget is that all the cytokines in our body work together through a complicated network. If we just block one thing, like TNF, sure it might aid in rheumatoid arthritis, but what about all the other duties that TNF alpha fulfills?
Can someone really risk the possibility of curing rheumatoid arthritis, just to feel better and less pain, but increase their risk to CANCER? Cancer is dangerous by itself, but maybe some people still see this as an option, just because their arthritis is that severe.
Even if blocking TNF is a lot better than other treatment ideas, I think it will be a long time before the government truly approves something this dangerous.
I ditto what Leon said. In order to truly understand what lengths one would go to for pain relief, you would have to experience that same degree of pain. Aside from understanding the physiological elements of arthritis, my knowledge about its physiological and psychological effect is quite limited. However, the severe impairment resulting from arthritis is apparent, even to those who have never experienced it.
ReplyDeleteAlthough I have yet to experience such a debilitating disease, if I were in such a situation, I believe I would ride out the disease until a safer alternative comes along. However, this thought may change entirely if I were to actually develop arthritis as the pain and suffering associated with arthritis may cause me to consider other more dangerous alternatives. Many may consider chronic pain to be worse than living a shorter pain-free life.
In terms of what Leon mentioned regarding the alteration of our body chemistry, any tampering can have a multitude of potential consequences. Almost everything in our body is linked in some way and meddling with one factor can cause a series of unforeseen effects. However, it all boils down with what the victim considers to be more devastating: being unable to perform everyday tasks properly or knowing that there’s an increased risk for cancer with a potential for regaining daily function.
You make a great point, Leon. I really think that was what the researchers were saying in last week's article on cytokines. Instead of targeting potentially harmful cytokines and eliminating their functions, we have to take more time to understand each cytokine's role and position in that super complicated network inside our body. I feel that if we spend more time and money (hence, research) on figuring out how these elements intertwine within the web, we would have a greater chance of discovering the main troublemaker and acting on it.
ReplyDeleteThe problem is, as you said, this network is just so complicated and it seems like there are just more and more new members of cytokine families being discovered every year. If there are constantly new elements added to this already hectic network, how do we keep up? Perhaps the reason why we still haven't found a cure for rheumatoid arthritis is because there are still so many undiscovered cytokines and markers and we need to know how these fit in with our body's network.
I agree with Leon, Richard, and Angela. It is definitely a personal choice about whether an individual decides to take medication in order to relieve the pain from arthritis while possibly causing harm to other parts of your body. I feel like with inhibitors and blockers in general, while you may be helping one aspect of your body, there’s always a risk to other parts of your body. While it was previously discussed that inhibiting TNF could affect the regulation of other cytokines, it can make our body susceptible to foreign pathogens and other illnesses. Like all immunosuppressants, TNF inhibitors increase the risk of infections. Rheumatoid arthritis is associated with an increased risk for infection as it is; the addition of TNF inhibitors increases the risk of acquiring an infection significantly. In addition, TNF inhibitors decrease the efficiency of protein-based vaccines that are T cell dependent such as hepatitis B virus, viral influenza A and B, human papilloma virus, and tetanus. When someone may be deciding between taking TNF inhibitors in order to relieve arthritis symptoms while having cancer, they would not only have to think how it would affect the levels of other cytokines, but how it would also increase his or her susceptibility to other illnesses and how it could possibly affect other organs in his or her body. I feel that inhibiting a cytokine may only be temporary solution because our main goal is always to maintain homeostasis and by inhibiting something that is a normal part or process of our body, we are changing what should be occurring naturally.
ReplyDeleteSource: https://www.aarda.org/infocus_article.php?ID=61
I agree with Richard in the sense that ameliorating one disease with the potential to gain another disease as severe as cancer doesn't sound worth it at first, but it depends on the situation of the patient. In terms of the pain experienced by the patient physiologically and psychologically, I believe it comes down to the mental strength/health of the patient. As Richard mentioned, I would also attempt to endure the disease until a more securing/safer alternative would come along. In today's world, the word "cancer" carries such a large amount of scare that I think many patients would opt to receive treatment that is less prone to attaining cancerous cells.
ReplyDeleteTo me, that boils down to mental strength to endure the physical pain and frustration in living every day with inadequate ability to perform simple daily functions. That being said, I also have never experienced a debilitating disease either and that makes it close to impossible to say what kind of treatment I would or would not accept for RA. If a patient is in such pain and frustration that induces suicidal psychology, I think that it would be best to live a pain-free life that may end up being shorter in the long run.
I also agree with Leon that in order to find a treatment that will not put us in a dilemma of which alleviation technique to use, we must focus more on the known cytokines and their true characteristic functions in disease. I believe that we are slowly but surely progressing towards finding clinical pharmaceuticals as well as more so osteopathic remedies to treating rheumatoid arthritis.
You all have great points! I agree that the majority of us can't say much about "choosing" one disease over the other because we don't know what the pain feels like. It could be excruciating to some patients, a kind of pain that we could not even imagine.
ReplyDeleteZinnia, the part about TNF inhibitors and vaccines is interesting! That's a perfect example of how these therapeutics may be helping us with one aspect of our body but at the same time hurting us in another part of our body. You make a great point about homeostasis within the body. I'm surprised that researchers haven't focused more on the balance that our bodies need. Actually, I found it interesting how some of the studies from this week's articles were trying to show how effective a specific cytokine inhibitor could be in treating rheumatoid arthritis. One study showed support for IL-1 and the other for IL-17, but I think the most important thing to understand, as you all said, is that our body is ridiculously complicated and that as of right now, no single medication can "fix" arthritis without negatively tweaking other bits and pieces of us.