Q & A Library

I was asked about these drugs by a woman whose husband was being treated for psoriatic arthritis, a type of arthritis that usually occurs among people who have the skin disease psoriasis. The caller said her husband had been treated with methotrexate, a powerful immunosuppressive drug, and had been switched to Enbrel, a much newer, equally powerful immunosuppressive that works in a different way.

I told about a patient of mine with rheumatoid arthritis, who was put on Enbrel. Her symptoms vanished as if by magic, but within six months she developed uterine and breast cancer, both probably influenced by the drug. Enbrel blocks some functions of the immune system, increasing susceptibility to serious infections, anemia and malignancies. Because of these possible and very serious adverse reactions, I recommend using Enbrel only as a last resort for autoimmune diseases that do not respond to other measures.

Both psoriatic arthritis and rheumatoid arthritis result from the immune system attacking the body's own tissues. These reactions may be triggered by infection, tissue injury, or emotional trauma in people with a genetic predisposition to them.

I am not opposed to using prednisone, methotrexate, and other immunosuppressive drugs for the short-term management of severe cases, but I advise experimenting with more natural methods of long term control. These include:

• Following a low-protein, high carbohydrate diet; minimizing consumption of foods of animal origin.
• Experimenting with fasting and with elimination diets; rheumatoid arthritis especially, often responds to these changes.
• Eliminating milk and milk products including commercial foods made with milk.
• Avoiding all polyunsaturated vegetable oils, margarine, vegetable shortening and products made with partially hydrogenated oils of any kind. Use olive oil as your main fat.
• Increasing intake of omega-3 fatty acids by eating more cold water fish, walnuts or fresh ground flax seeds. Or taking a fish oil supplement.
• Eliminating or reducing intake of coffee and tobacco; both have been linked to an increased risk for rheumatoid arthritis.
• Getting regular aerobic exercise (swimming is best for those with arthritis).
• Practicing relaxation techniques; visualization can help moderate auto immune responses; psychotherapy can help change emotional states that keep the immune system off balance and hypnotherapy and guided imagery are also useful.
• Avoiding health care practitioners who make you feel pessimistic about your condition.
• Trying other medical systems such as traditional Chinese medicine or Ayurveda, which often do well with autoimmune conditions. 

Andrew Weil, M.D.