This week we’re bringing you the another question submitted by our one of our clients and social media followers! If you have a question you’d like to submit, please email us here.

Question:
How do we know when we achieve pharmaceutical remission? Does remission have any pain?  Fatigue?

Answer:
There are different ways to look at remission. For patients this can mean being pain free, but having no pain does not necessarily mean the disease process is not active.  To truly assess remission, rheumatologists evaluate inflammatory markers in blood work as well as images of the joints such as ultrasound, X-Ray or MRI, in addition to asking questions about your pain, morning stiffness, and ability to function at home, work, and socially. In addition the “hands on” assessment of your joints is also important.  Achieving full remission is easier to achieve when treatments to stop disease progression are started early; ideally within the first year after symptoms are first identified. Remission can also be easier to achieve in non-smokers and those who are not overweight as fat cells produce inflammation themselves.  The goal of treatment ideally is to achieve remission, but as this is not always possible, achieving low disease activity can still make a significant difference in a person’s quality of life and preventing joint damage.

Fatigue can certainly be reduced when disease is under control, however, some people can continue to have fatigue despite their arthritis being well controlled. Pain, inflammation and the stress of illness overtime can place a large burden on the body if a disease has not been well managed. This may lead to adrenal stress, whereby fatigue can remain despite low disease activity. The same can be said for pain. An increased sensitization to pain can occur in people who have experienced untreated pain overtime. If the pain is coming from tissue beyond the joints and it is experienced as a generalized pain sensitivity, then this type of pain may not necessarily resolve even though the inflammatory condition is in good control.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health.  Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

This week we’re bringing you the another question submitted by our one of our clients and social media followers! If you have a question you’d like to submit, please email us here.

Question:
Is it safe to have the Shingles vaccine if you are on Prolia?

Answer:
The shingles vaccine used most often is called Shingrix which is a non-live vaccine.  Prolia is a biologic therapy for the treatment of osteoporosis which does not increase infection risk.  It is fine to receive Shingrix while taking Prolia.

Even when taking a biologic therapy for an autoimmune condition which does increase infection risk, there is no problem in receiving any non-live vaccine including Shingrix.

This week we’re bringing you the another question submitted by our one of our clients and social media followers! If you have a question you’d like to submit, please email us here.

Question:
It is my understanding that many of the vaccines that are being developed for COVID-19 work best with people in the middle age group, i.e., not children and seniors.  Given that many of us who have Rheumatoid Arthritis are seniors, will the vaccines be effective for us too?

Answer:
Thank you for your question regarding vaccination development for COVID-19.  There are currently several vaccines being researched and they are not all produced the same way. It is true that an immature immune system, just as an older immune system or one of an immunocompromised person, may not respond as well to a vaccine than a healthy young adult.  Higher levels of immune response can be generated for all ages, based on the way a vaccine is produced.  Often a vaccine requiring a series of 2 shots may offer a higher level of protection.  Of the vaccines being researched, some will require 2 doses and the processes being used to produce these vaccines is not all the same.  We won’t have the answer to the level of immune protection that each of these vaccines will offer in different age groups or in compromised individuals until the research is complete.  Once vaccines are available, ongoing ‘post-market’ research will be needed to answer many questions, including how long immune protection will last once a vaccine is received.  It may be necessary to repeat certain vaccines annually.

Regardless of which type of vaccine is available to Canadians, the concept of herd immunity is so important!  Based on the rate of transmission of a virus, we calculate what percentage of the population needs to be vaccinated to offer protection to everyone; including the most vulnerable.  This will be a very important calculation to have when we get the COVID-19 vaccine. Immunizing a large portion of the population will be required.

Here is a great summary of how vaccines are made and the types of vaccines under development for COVID-19 currently.

This week we’re bringing you the first of our questions submitted by our clients and social media followers! If you have a question you’d like to submit, please email us here.

Question:
My daughter has colitis and is on Remicade. My husband and I both work in the school system. We work in small communities where the incidence of Covid-19 has been low, however, when we go back to school in the fall, will we be putting our daughter at risk? How can we protect ourselves?

Answer:
Thank you for submitting a question which is on many people’s minds in terms of the risk which a return to school will pose to students, teachers, and the members of their families. What we have learned from the experience in China is that people who are well controlled on biologic therapies, such as Remicade (infliximab) for inflammatory bowel disease, did not have a higher incidence of getting Covid-19 than the general public. If they did get the virus, they did not do worse than the general public. This is very reassuring and tells us that the most important thing for your daughter to do is stay on treatment to keep her disease in good control. This will increase her resilience for fighting any infection. Of course if anyone on treatment gets a viral or bacterial infection, we hold their infusion until the infection has resolved.

As decisions are made closer to September, certainly the most vigilant approach would be that all staff and students wear a face covering and practice hand washing/sanitizing when entering and leaving any classroom/library. This will be dependent on the Ministers of Health and Education’s decision with the information they have at their disposal at that time. Reduced numbers within the classroom will also be helpful. When coming home after working in an environment with many people, an extra layer of protection for your family is to remove your clothing before/upon entering your home, and have a shower. Also ensure that everyone in the household has their adult/childhood vaccinations up to date. Getting plenty of rest, reducing stress, drinking water, eating a balanced diet of whole foods, and getting 150 minutes of exercise per week helps make our bodies more resilient and should always be a foundation for good health and prevention of disease.

Instead of bringing you a traditional blog this week, we want to hear from you! Do you have any questions you’d like answered? We are happy to report that we have close to 4000 followers on our weekly blog. We receive many kind comments and appreciation for the information we are sharing. But, we want to make sure we’re answering the questions YOU want answered. Send an email with any questions you might have to cwhiskin@charltonhealthcare.com!

This week I was asked when a biologic indicates it is humanized, does that mean it is a protein donated from another person?

This is NOT the case.  Biologic therapies used to treat autoimmune conditions mimic the look of antibodies composed of complex proteins.  They are made in a bioreactor using mammalian cells that have been biogenetically engineered to create a protein that is highly similar to proteins created by the human body. Proteins are made up of a sequence of amino acids.

When the sequencing is the same as that found in human proteins,
we refer to it as ‘humanized.’

The most common cells used for this purpose are Chinese hamster ovary cells.  Mouse cells (referred to as chimeric) have also been used to produce biologic treatments, but their structure could deviate a little from human proteins.  Regardless of the cell used to produce the biologic therapy, the end product is highly purified.