What's next after TNF drugs don't work?

My father who is in his late 50s has been battling RA for some years now. He started off with your regular cocktail of medication, prednisone, and your other various DMARDs but those didn't work. So his doctor opted to try the TNF drugs. He has tried Enbrel, Humaira, and I would like to say one other TNF which includes a fusion of roughly 8 hours or so for the first one and the second fusion is roughly 2-3 weeks later of roughly the same amount of time. Unfortunately it has not worked for him. He continues to take his prednisone as well as receive corticosteroid shots once every few months.

He usually describes his pain as being a 5 or 6 after waking in the morning.

I would like to know what is next as far as drugs or medications go? He said his doctor has no clue what to do next. I find that hard to believe. I understand that there are more than just 3 TNF drugs and that if one does not work, there is a chance another may. Or do most doctors try a few TNF drugs and after failing said drugs they come to the conclusion that TNF medication will not work well for this patient?

My next thought is to attempt to have my father change his diet, something like the Paleo diet to see how that affects him.

Any ideas?

Hi, FArthritis...it is so ironic that I saw your post today as I am in the exact situation!...I have had RA since I was two and am now 44...I had a great remission run from about 14 years old to 2007, when the disease became extremely active again...I tried Methotrexate both in injectable and pill form; I was unable to tolerate it due to debilitating nausea...I was put on Enbrel next, an anti-TNF drug, and it gave me drug-induced lupus...I was put on Orencia next, which is about a 30 minute infusion once per month...Orencia took about six months to kick in and then it worked for about 3.3 years...in June of this year, my rheumatologist believed that the disease was progressing and that the Orencia was no longer working, so she switched me to Cimzia...Cimzia is an anti-TNF drug but is structured differently than the others as Cimzia has a protein attached to it...so, even though Enbrel had given me drug-induced lupus, she felt that I would respond to Cimzia...well, shortly after being switched, I began to go downhill...I began having increased joint pain and stiffness, fatigue (which I never had an issue with before) and a "mystery" rash that would sporadically appear on my upper arms that was reminiscent of the lupus-like rash that I had when I was on Enbrel...my doctor kept telling me that she didn't understand and, even though Cimzia is supposed to work (if it does) within one-two months, she kept telling me to give the Cimzia a try...so I kept taking the Cimzia, and I kept getting worse..in early September, my rheumy emails me that I tested positive for Lyme, which would explain a lot of things (she felt it explained my joint pain, rash and fatigue)...so she put me on a strong antibiotic called Doxycycline to treat the Lyme; I was unable to tolerate it as it started repeated bouts of vomiting...so, she sent me to an infectious disease doctor who came across as uninterested..he was not convinced I had Lyme and he said that, even if I did, my test results indicated a very new case of Lyme, as in only a couple of weeks old...so, that would NOT explain how I had been feeling!

My rheumatologist, before I tested positive for Lyme, had given me the name and number of a hot shot rheumy at a well-known hospital in NYC and had wanted me to make an appointment to see him as she was running out of ideas...well, after I saw the infectious disease doctor, I was pissed as it seemed no one had any ideas and I was going downhill...two weeks ago, I experience crushing fatigue and joint pain and was out of work, in bed, for an entire week!...other than for a surgery, I am NEVER out of work for that long...so, I made an appointment with this rheumy in NYC...I saw him this past Tuesday...guess what?...it took him all of ten minutes to diagnose me with drug-induced lupus from the Cimzia!!...I can't even tell you how angry I was...my rheumy should have caught this especially since she knew how I had reacted to Enbrel...at this point, my body is out of control; I have intermittent fevers and sweat buckets, the fatigue is debilitating some days, the joint pain is particularly bad - I had my knees fully replaced in 2008 and right now, they ache so bad it is difficult to walk!...the new rheumy said that my knees are an indication of how badly my body is inflamed right now - even though the knees are titanium, there is still tissue in there that can become inflamed and that is what is happening.

He told me to take Prednisone and pain medication as needed, and to cease taking the Cimzia, obviously...he said he would switch me to Actemra, which targets the IL-6 cytokine - Actemra is NOT an anti-TNF...it is an infusion that takes about one hour...he said there is ALWAYS a different medication to take...I also take Leflunomide (generic for Arava daily).

So, right now, I am part-time at work until I feel better...I tried taking the Prednisone on Wednesday and it tore my stomach apart (yes, I took it with food), inducing repeated vomiting so I am only taking pain meds...I terminated my rheumy on Wednesday and switched to the new rheumy.

My advice to you is to do your own research and then to find a new rheumatologist as it sounds like yours has given up with does not bode well for the patient, which is your father.

I hope that what I have gone through can help you in some way.

Hi! I know this thread is over a year old but hopefully someone will read this and give me some advise. Please.:)

So....I was receiving Remicade infusions to help with my psoriasis shortly after the birth of my daughter. One month after my 6th infusion I woke up in so much pain that it felt like I had been pushed down a flight of stairs. I could barely walk or lift my arms. Then everyday after that the pain would migrate to different parts of my body. Then....the chest pain kicked in. It felt like I was having a heart attack! Scary! I knew it was the Remicade. I went to my dermatologist who prescribed the Remicade and he told me I just needed another infusion and that I now have PA. I disagreed because I never had joint pain before taking the Remicade.

After several different blood tests from my Iternal Medicine Dr...... Positive ANA, Extremely low Vit. D levels, & liver enzymes were abnormal. DRUG INDUCED LUPUS! Although they say it's rare, I guess we are just a few of the lucky ones??? So I've been taking prednisone and tramadol for the last 5 months and the chest pains are gone and only have pain in my feet and hands. My P is full blown out of control now! My rheumy prescribed methotrexate which I'm too scared to take because it is a category X drug and I would love to have a second child in the near future. I'm already 38 so that doesn't leave me much time.

So....can you get drug induced lupus twice? After reading your post I would say yes and I would probably be crazy to start injecting myself with this humira that they gave me at my last dr.s visit. It is sitting on my counter and I just have to shake my head when I look at it. As much as I would love clear skin...it's not worth getting DIL again! So...I thank you for your posts because they have helped me make my decision!

Thanks Chartreux!

The methotrexate does sound scary! But if I did take it...I wouldn't have to worry about getting DIL again!

My last rheumy appt. my dr. recommended the Humira. When I asked him if I could have the same reaction that I had with Remicade....He told me to refresh his memory on what happened!!!! I understand they see lots of patients and I'm just a number, but he could've looked at my chart before coming in!!! The reason why I have a rheumy is because of the DIL and he forgot! So annoying!

Well I guess OBAMACARE has kicked in. My insurance company is directing my treatment rather than my Rhuemy. I've tried Cimzia and Orencia with no luck. Rhuemy wanted to try Actemra, but insurance company insists we try Humira and Embrel first. Rhuemy wants to try something other than a TNF drug now, but insurance won't pay until we follow THEIR doctor's instructions. In the meantime I'm on pain killers and now MORPHINE until we start Embrel which is bound to be a bust. These will be at least 4 months of wasted money and additional physical deterioration I have to endure.

I also tried all the anti-tnf drugs. First Remicade infusions, then Enbrel followed by Humira. I didn't believe they were helping, but sometimes its hard to know if they may have helped a little. My RA seems to go through periods of more or less painful. I finally tried Cimzia, and I am sure its helping. I can see the difference when it is getting near to my injection time. So, try other drugs if some don't work. It could be that some are cleared more readily by our immune systems than others and don't have time to do their work...everyone's immune system is different.

I was diagnosed with JRA as a kid and I'm now 36. I've been on all the mainline ra meds with no help. Currently I receive Cytoxan infusions and IVIG. My local rheumy referred me to Duke whn I started having trouble with Intersticial Lung Disease which was caused by the RA. If you seem to have failed the normal meds, you might want to look at a research hospital for your care.

The meds are scary. However, in my case, untreated RA is even more scary. RA can attack your organs. I've had a feeding tube due to stomach involvement, many bouts of pericarditis, and I'm in the process of getting eyedrops tailored to just me using my blood serum. Main reason for the Cytoxan is that it is known to treat lung involvement. A few years ago drs threw the words "lung transplant" around.

I believe that there is a magic med of each of us out there-somewhere. I just wish it didn't talk so long to find it:)