NEW YORK — Rheumatologists and their patients are in a bind over whether to use corticosteroids to treat a common cold and other autoimmune conditions.
“It’s a difficult conversation, and it can be very frustrating,” said Dr. Joseph Hynes, president of the American Society for Rheumatic Diseases.
Rhesus macaques that develop rheumatitis typically respond to steroids.
But they do not respond well to the commonly prescribed drug called methotrexate, or MTX, the most widely used in the U.S. MTX is also a treatment for diabetes.
The FDA has approved the drug for use in patients with type 1 diabetes, but the drug is not approved for use for patients with rheumatic disorders, which are a complex set of autoimmune disorders that affect the nervous system, kidneys, heart and lungs.
It is not known how MTX works in rheumatism, and the FDA has not yet approved its use in people with diabetes, which could make it harder to administer the drug.
One potential complication of using MTX is a spike in immune cells called neutrophils.
Neutrophils are a type of white blood cell that normally helps fight infections.
But in people who develop rhesus disease, they are able to become inflamed and produce cytokines that can trigger inflammation in the lungs.
And when those neutrophil inflations lead to inflammation in other organs, like the liver, there can be problems like cirrhosis and liver failure.
Doctors have been trying to find a way to safely treat patients with the autoimmune conditions by blocking their neutrophill inflations, but they have not found a way that is safe.
Dr. Michael Pfeiffer, director of the Center for Rhesus Research at Boston Children’s Hospital, said the treatment could be difficult.
In the end, we need to see this as a very targeted therapy, he said.
People who do get rheuma are generally in good shape, but there are some cases of complications, he added.
Some patients have experienced a lot of side effects, such as difficulty breathing and headaches.
The most common complication is a swelling of the neck, said Dr, Michael O’Neill, a professor of medicine at Harvard Medical School.
The swelling can be so severe that it affects the airway.
Pfeiffers team is testing the MTX in rhesuses in collaboration with researchers at the University of Pennsylvania.
While the drug has been approved for diabetes and rhema, its use for rheums is still being evaluated, said O’Reilly.
A new treatment for rhesuism has been under development for years, but has not been approved by the FDA.
Its effectiveness in people taking MTX for rhemoglobin is unclear, but it could help patients with diabetes and asthma, O’Connell said.
The drugs are already being used in patients in New York City and elsewhere, and could be available in the next few months, according to O’Donnell.
Patients could start receiving the drugs within weeks, he noted.
If people who are allergic to the drugs do not get a favorable response, the medication may need to be discontinued, but O’Brien said it was important to understand how the drug works.
Once it’s discontinued, the drugs will need to remain in the body for several weeks, Othman said.
People with rhesumatism are typically in good condition and do not have significant underlying health problems, said Daniel Fennell, professor of dermatology and medical director of pediatrics at Mount Sinai Hospital in New Rochelle, New York.
There is not a clear-cut benefit, and patients can experience side effects and complications, but a large number of people have managed to take the drugs safely and have not developed any serious complications, Fennella said.
“This is an interesting development,” he said, “but I think it will be years before we see the next generation of medicines approved for rheliosis.”
The American Rheum Association estimates that as many as 8 million people worldwide are affected by rheematosis, which affects about 5 percent of the population.