Put Your Health First: Learning What Works for Your Chronic Inflammatory Illness
Posted: May 01, 2019 | Word Count: 2,310
Content sponsored and provided by Pfizer.
As an emergency management contractor and former paramedic, Jared H. has experience helping others navigate difficult health situations. But the tables turned in his 30s, when Jared began experiencing persistent joint pain and swelling in his knees and ankles. He wasn’t sure what was happening, but he knew that something was not right.
After initial visits with an orthopedic specialist, Jared was referred to a rheumatologist who diagnosed him with moderate to severe rheumatoid arthritis (RA) – a chronic, inflammatory, autoimmune disease of the joints.
Jared accepted his diagnosis and took a proactive approach, with his doctor, to treating his condition, drawing on his training to act quickly and efficiently. Although he soon realized that when it comes to RA, the road ahead might not be as straightforward as he’d hoped.
“At the time I told my doctor ‘OK, if that’s what you say is wrong with me, let’s get it fixed,’” Jared said. “But I learned very quickly that there is not a simple fix. Everyone is different, and everyone’s RA is different.”
Instead, Jared decided to focus on the things he could control, like working with his doctor on a treatment plan to help manage his symptoms. He cycled through various medications and treatment plans, but over time each stopped working well enough and he was still experiencing RA symptoms. At this point, Jared was suffering from increased joint pain and swelling, in addition to decreased range of motion in his hands and wrists.
“It hurt physically and emotionally,” he said. “I stopped doing things that I enjoyed with my family and friends and began to accept that I would always have some level of joint pain.”
To further complicate things, Jared was frequently on the road, relocating to new cities as part of his job. He knew he needed to find a treatment plan that would work for him.
About five years ago, Jared was in a new city and met with a new rheumatologist to talk about managing his RA. She thoroughly assessed his condition and told him about XELJANZ® (tofacitinib) 5 mg twice daily tablets, an oral medication for adults with moderate to severe RA in whom methotrexate did not work well enough. Jared’s rheumatologist reviewed the potential side effects of XELJANZ with him (the medication is taken twice daily and has a BOXED WARNING for serious infections and malignancies). XELJANZ/XELJANZ XR can lower the ability of your immune system to fight infections. Some people can have serious infections while taking XELJANZ/XELJANZ XR, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. You should not start taking XELJANZ/XELJANZ XR if you have any kind of infection unless your healthcare provider tells you it is okay. You may be at a higher risk of developing shingles (herpes zoster). Your healthcare provider should test you for TB before starting XELJANZ/XELJANZ XR and during treatment. See Important Safety Information below.
For the first time in a while, he felt hopeful. Jared began to see results within the first month of taking XELJANZ. Within six months, he was performing certain common daily activities, such as holding a coffee mug and picking things up from the floor, with less joint pain than before.
By focusing on his health and working with his rheumatologist, Jared found a treatment plan that helped him work toward his goals. With XELJANZ and his RA treatment plan, he was able to manage his symptoms. Common side effects of XELJANZ/XELJANZ XR in rheumatoid arthritis patients include upper respiratory tract infections (common cold, sinus infections), headache, diarrhea, nasal congestion, sore throat, and runny nose (nasopharyngitis), and high blood pressure (hypertension).
Life may be different now, but Jared says the decision to put his health first is one of the best he’s made as part of his treatment journey. His advice to others who may be in a similar situation? Don’t give up.
“There are options available,” Jared says. “It’s about knowing what you want and partnering with a rheumatologist who will help you find a treatment plan that works for you.”
To learn more about XELJANZ and hear from others who are living with RA, visit RA.XELJANZ.com.
What is XELJANZ/XELJANZ XR?
XELJANZ/XELJANZ XR (tofacitinib) is a prescription medicine called a Janus kinase (JAK) inhibitor used to treat:
- Adults with moderately to severely active rheumatoid arthritis in whom methotrexate did not work well
- Adults with active psoriatic arthritis in which methotrexate or other similar medicines called nonbiologic disease-modifying antirheumatic drugs (DMARDs) did not work well
It is not known if XELJANZ/XELJANZ XR is safe and effective in children or in people with Hepatitis B or C.
XELJANZ/XELJANZ XR is not recommended for people with severe liver problems.
IMPORTANT SAFETY INFORMATION
What is the most important information I should know about XELJANZ/XELJANZ XR?
XELJANZ/XELJANZ XR may cause serious side effects, including:
Serious infections. XELJANZ/XELJANZ XR can lower the ability of your immune system to fight infections. Some people can have serious infections while taking XELJANZ/XELJANZ XR, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections.
- Your healthcare provider should test you for TB before starting and during XELJANZ/XELJANZ XR treatment, and monitor you closely for signs and symptoms of TB infection during treatment.
You should not start taking XELJANZ/XELJANZ XR if you have any kind of infection unless your healthcare provider tells you it is okay. You may be at a higher risk of developing shingles (herpes zoster). People taking the higher dose (10 mg twice daily) of XELJANZ have a higher risk of serious infections and shingles.
Before starting XELJANZ/XELJANZ XR, tell your healthcare provider if you:
- think you have an infection or have symptoms of an infection, such as fever, sweating, or chills; cough; blood in phlegm; warm, red, or painful skin or sores on your body; burning when you urinate or urinating more often than normal; muscle aches; shortness of breath; weight loss; diarrhea or stomach pain; or feeling very tired
- are being treated for an infection
- get a lot of infections or have infections that keep coming back
- have diabetes, chronic lung disease, HIV, or a weak immune system. People with these conditions have a higher chance for infections
- have TB, or have been in close contact with someone with TB
- live or have lived in, or have traveled to certain parts of the country (such as the Ohio and Mississippi River valleys and the Southwest) where there is an increased chance for getting certain kinds of fungal infections (histoplasmosis, coccidioidomycosis, or blastomycosis). These infections may happen or become more severe if you use XELJANZ/XELJANZ XR. Ask your healthcare provider if you do not know if you have lived in an area where these infections are common
- have or have had Hepatitis B or C
After starting XELJANZ/XELJANZ XR, call your healthcare provider right away if you have any symptoms of an infection. XELJANZ/XELJANZ XR can make you more likely to get infections or make worse any infection that you have.
Cancer and immune system problems. XELJANZ/XELJANZ XR may increase your risk of certain cancers by changing the way your immune system works. Lymphoma and other cancers, including skin cancers, can happen in patients taking XELJANZ/XELJANZ XR. People taking the higher dose (10 mg twice daily) of XELJANZ have a higher risk of skin cancers. Tell your healthcare provider if you have ever had any type of cancer.
Some people who have taken XELJANZ with certain other medicines to prevent kidney transplant rejection have had a problem with certain white blood cells growing out of control (Epstein Barr Virus–associated post-transplant lymphoproliferative disorder).
Tears (perforation) in the stomach or intestines. Tell your healthcare provider if you have had diverticulitis (inflammation in parts of the large intestine) or ulcers in your stomach or intestines. Some people taking XELJANZ/XELJANZ XR can get tears in their stomach or intestine. This happens most often in people who also take nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or methotrexate. Tell your healthcare provider right away if you have fever and stomach-area pain that does not go away and a change in your bowel habits.
Serious allergic reactions have happened in patients taking XELJANZ/XELJANZ XR. If you have swelling of your lips, tongue, throat, or get hives, stop XELJANZ/XELJANZ XR and call your healthcare provider right away.
Changes in certain lab test results. Your healthcare provider should do blood tests before you start receiving XELJANZ/XELJANZ XR, and while you take XELJANZ/XELJANZ XR, to check for the following side effects:
- Changes in lymphocyte counts. Lymphocytes are white blood cells that help the body fight off infections.
- Low neutrophil counts. Neutrophils are white blood cells that help the body fight off infections.
- Low red blood cell count. This may mean that you have anemia, which may make you feel weak and tired.
Your healthcare provider should routinely check certain liver tests.
You should not receive XELJANZ/XELJANZ XR if your lymphocyte count, neutrophil count, or red blood cell count is too low or your liver tests are too high. Your healthcare provider may stop your XELJANZ/XELJANZ XR treatment for a period of time if needed because of changes in these blood test results.
You may also have changes in other laboratory tests, such as your blood cholesterol levels. Your healthcare provider should do blood tests to check your cholesterol levels 4 to 8 weeks after you start XELJANZ/XELJANZ XR, and as needed after that.
What should I tell my healthcare provider before taking XELJANZ/XELJANZ XR?
Before taking XELJANZ/XELJANZ XR, tell your healthcare provider about all of your medical conditions, including if you:
- have an infection
- have liver problems
- have kidney problems
- have any stomach area (abdominal) pain or been diagnosed with diverticulitis or ulcers in your stomach or intestines
- have had a reaction to tofacitinib or any of the ingredients in XELJANZ/XELJANZ XR
- have recently received or are scheduled to receive a vaccine. People taking XELJANZ/XELJANZ XR should not receive live vaccines but can receive non-live vaccines
- plan to become pregnant or are pregnant. XELJANZ/XELJANZ XR may affect the ability of females to get pregnant. It is not known if this will change after stopping
XELJANZ/XELJANZ XR. It is not known if XELJANZ/XELJANZ XR will harm an unborn baby.
- Pregnancy Registry: Pfizer has a registry for pregnant women who take XELJANZ/XELJANZ XR. The purpose of this registry is to check the health of the pregnant mother and her baby. If you are pregnant or become pregnant while taking XELJANZ/XELJANZ XR, talk to your healthcare provider about how you can join this pregnancy registry or you may contact the registry at 1-877-311-8972 to enroll
- plan to breastfeed or are breastfeeding. You and your healthcare provider should decide if you will take XELJANZ/XELJANZ XR or breastfeed. You should not do both. After you stop your treatment with XELJANZ/XELJANZ XR do not start breastfeeding again until 18 hours after your last dose of XELJANZ or 36 hours after your last dose of XELJANZ XR.
- Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take any other medicines to treat your rheumatoid arthritis or psoriatic arthritis. You should not take tocilizumab (Actemra®), etanercept (Enbrel®), adalimumab (Humira®), infliximab (Remicade®), rituximab (Rituxan®), abatacept (Orencia®), anakinra (Kineret®), certolizumab (Cimzia®), golimumab (Simponi®), ustekinumab (Stelara®), secukinumab (Cosentyx®), vedolizumab (Entyvio®), azathioprine, cyclosporine, or other immunosuppressive drugs while you are taking XELJANZ or XELJANZ XR. Taking XELJANZ or XELJANZ XR with these medicines may increase your risk of infection.
- Tell your healthcare provider if you are taking medicines that affect the way certain liver enzymes work. Ask your healthcare provider if you are not sure if your medicine is one of these.
Taking XELJANZ/XELJANZ XR
- Take XELJANZ 2 times a day with or without food.
- Take XELJANZ XR 1 time a day with or without food for rheumatoid or psoriatic arthritis. Do not take XELJANZ XR for ulcerative colitis.
- When you take XELJANZ XR, you may see something in your stool that looks like a tablet. This is the empty shell from the tablet after the medicine has been absorbed by your body.
- For the treatment of psoriatic arthritis, take XELJANZ/XELJANZ XR in combination with methotrexate, sulfasalazine or leflunomide as instructed by your healthcare provider.
What are other possible side effects of XELJANZ/XELJANZ XR?
XELJANZ/XELJANZ XR may cause serious side effects, including Hepatitis B or C activation infection in people who carry the virus in their blood. If you are a carrier of the Hepatitis B or C virus (viruses that affect the liver), the virus may become active while you use XELJANZ/XELJANZ XR. Your healthcare provider may do blood tests before you start treatment with XELJANZ/XELJANZ XR and while you are using XELJANZ/XELJANZ XR. Tell your healthcare provider if you have any of the following symptoms of a possible Hepatitis B or C infection: feel very tired, little or no appetite, clay-colored bowel movements, chills, muscle aches, skin rash, skin or eyes look yellow, vomiting, fevers, stomach discomfort, or dark urine.
Common side effects of XELJANZ/XELJANZ XR in rheumatoid arthritis and psoriatic arthritis patients include upper respiratory tract infections (common cold, sinus infections), headache, diarrhea, nasal congestion, sore throat, and runny nose (nasopharyngitis), and high blood pressure (hypertension).
Please see full Prescribing Information, including BOXED WARNING and Medication Guide.
 Arthritis Foundation. What Is Rheumatoid Arthritis? https://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/what-is-rheumatoid-arthritis.php. Accessed 12/13/18.