Arava For Consideration

By On · 2 Comments

Upon my last visit to the rheumatologist, he suggested if I’m not seeing results from my current meds I can try Arava. “Never heard of that one before”, I said. Some patients have had success he tells me, and since I’ve already tried methotrexate without any luck this apparently is the next step.

But how do I go about taking yet another new prescription without still knowing what I am treating? Besides having one clue (a brother with severe psoriasis), not one of my relatives has had a case like mine. And most of my grandparents and their parents are no longer here to ask. Sometimes I wish I knew to ask questions while they were still here. As far as I know there were a few cases of osteoarthritis, but nothing of the autoimmune variety.

So that leads me back to the next step in my investigation… or should I say treatment. Arava, or Leflunomide for those of us who like tongue twisters, is bright red on my hesitation radar. Anytime I notice severe liver injury as a possible side effect it makes me think twice. Not to mention it still feels like a treatment of symptoms rather than going after the cause. Another concern is the notation that Arava may remain in the body for up to 2 years after you stop taking it. I could go on and on about the other possible side effects or how many warnings mention the word fatal, but that seems to be the norm with most of the drugs used to treat rheumatoid arthritis or various other inflammatory autoimmune diseases.

After some searching, Arava appears to be controversial. When the FDA updates a medication with a box warning specifying, “risk of severe liver injury”, it makes me more than a little uneasy. Further details about the warning explain that death from liver failure  in over a dozen patients on the drug coincided with other medications they were taking that affect the liver. Regardless of how many other medications were involved, Arava has a definite affect on the body. I will continue to research Arava and other options in my quest to make an informed decision, but for now the side effects of this drug outweigh the symptoms I already experience.

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  • http://www.rheumablog.wordpress.com Wren

    I do understand your hesitation regarding Arava. I’ve been taking it for about two years, now, along with sulfasalazine, and it has kept my rheuma reasonably under control. Arava doesn’t treat symptoms, though–it changes and suppresses the immune system, which slows the progress of the disease. That in turn can lessen symptoms. I have severe RA, and while Arava hasn’t been a cure, I shudder to consider how much worse I’d feel, and how much more damage the rheuma might be doing to my joints, without it.

    I’ve had no side affects whatever from Arava. Remember to consider percentages as you make your decisions; those 12 deaths came from among many, many patients, the vast majority of whom do well while taking it. Those who died may also have had other issues that could have triggered liver damage, as well.

    These RA drugs are a true miracle–and a balancing act. I wish you the best as you make a decision. And I hope that your pain will soon be under control.

  • -brad-

    Thanks for the comment. It’s so nice to hear someone with a positive experience and no side effects. I think the toughest part for me still is not knowing what I’m treating. And I know testing negative for RA doesn’t necessarily mean I don’t have it or won’t have it. Nevertheless, I’m treading cautiously. You make a good point too about the balancing act. Finding a cause for autoimmune diseases is so tough because there can be a multitude of variables involved.