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In This Briefing:
If you subscribe to Scientific American and don’t remember reading an article in October titled “Peacekeepers of the IMMUNE SYSTEM” by Zoltan Fehervari and Shimon Sakaguchi (page 56), dig out the issue and read it. Its subject matter could be of significant consequence to flakers.
In a nutshell, a new type of T-cell in the immune system has been identified and is being studied. The authors call it a “T-reg” cell to differentiate it from the diverse population of T-cells (aka lymphocytes, a form of white blood cell). Normally T-cells behave like the signal corps in the army — identifying the enemy (invading things and substances) and signal the immune system’s combat troops (other kinds of cells) to come and do battle. Most of the biologic medications we take for P and other diseases are “modulators” or “interceptors” that, through very specific protein interactions, confound the communications issued by T-cells (under these drugs, these signal corpsmen can come and discover, but when they send out their calls to the troops their signals are “jammed” — hence no battle, which in the case of people who flake, means fewer flaming lesions).
The T-reg cells evidently police other T-cells and intervene if they discover their brethren are issuing ill-advised commands — which is what’s happening when a psoriasis lesion broils up on our skin for no apparent reason. The T-reg cells issue their own commands, which can result in the control of self-destructive immune system behavior — otherwise known as autoimmune disease. Autoimmune diseases include, along with psoriasis, type 1 diabetes, rheumatoid arthritis, multiple sclerosis, Crohn’s Disease, Lupus and many others.
Is there a new treatment lurking somewhere down the road from this discovery of T-reg cells? Could be. First we need to learn what is irregular about T-regs in people with autoimmune diseases. If there is some abnormality or deficiency in the ranks of the T-regs, it would be tested as a potential source in the cascade of conditions that result in autoimmune disease. If such a deficiency was permanently fixed, and the T-regs subsequently quelled the disease-perpetrating T-cells, the result might be a cure. On the other hand, if the deficiency was chronic and “incurable,” but a long-term palliative was found (like insulin injections are a long-term palliative to type 1 diabetes), administering the palliative to “fix” the T-regs might or might not be more effective than our current flock of biologics that interfere directly with signal corps T-cells. (Perhaps fixing T-regs would provide a broader field of positive consequences.)
Very interesting article! I was unsuccessful in gaining online access to the article when I pretended not to be a subscriber; however, there is an online subscription available (called SA Digital, $39/year when I checked today).
Dermacinz™ is a topical zinc-based product for skin psoriasis that’s been available “across the pond” for some time. Here’s its backstory in FlakeHQ...
Order from the U.S./Canada distributor via the web at:
I’ve been taking Humira for 10 months. For the first 7 months (Jan-Jul ’06) I was taking 40 mg subcutaneous injections every OTHER week (about 80 mgs per month). For the past 3 months (Aug-Oct ’06) I’ve been taking 40 mgs EVERY week (about 160 mgs per month) — twice the initial dose.
To understand the increased dosage in month 8, you need to know why I started Humira in the first place.
In 2005, I was using Raptiva and enjoying almost perfectly clear skin. There was one recalcitrant lesion on my right forearm — its color lightened from crimson to pink, but it continued to flake — and my ears flaked continuously through the year — more than they had before I started Raptiva. These two on-going problems were unable to curb the joy I was experiencing from being free of the numerous lesions that had covered almost every other area of my body. Problem was, Raptiva did not help my psoriatic arthritis. I manifest this disease most painfully in my knees; so, while I was enjoying clear skin, my knees were deteriorating steadily.
By the Fall of 2005 I was having difficulty walking, climbing steps to my attic office, and even driving. I was making frequent visits to my rheumatologist in the later half of 2005 and she and I discussed the relative merits of both Humira and Remicade. While neither of these rheumatoid arthritis biologics had been approved for skin psoriasis, both were garnering good results on psoriatic arthritics and my rheumy insisted the majority of her PA patients were claiming their skin improved using either of these, too. So, my derm supported my shift from Raptiva to Humira providing I used both in January to help mitigate the horrific rebounds that loads of people were experiencing when they stopped taking Raptiva.
I’m sure the “doubling up” with Raptiva and Humira in January helped; however, the rebound happened anyway (I wrote about it in the Sep-Oct update of FlakeHQ). For those first 7 months on Humira I enjoyed a return to trouble-free knees (I can hardly remember the pain that threatened to lay me up in late 2005). To me, this meant that Humira was behaving as promised. I felt I could put up with the worsening skin. I didn’t really think about the possibility of doubling the Humira dosage until my rheumy brought it up 7 months into my Humira therapy. I’d gone to that appointment thinking I might ask for a small dose of methotrexate to go along with the Humira for a few months — just to see if it would improve the skin (or at least stop the rebound). My rheumy brought up the double-dose Humira possibility, first. I didn’t even mention methotrexate.
Over the past three months on the Humira double dose, my skin rebound has stopped and, I think, symptoms are reversing. I haven’t shed any of the rebound lesions, per se — but they’ve changed color from the typical, bright, inflammation-red to salmon pink, an indication that “things are quieting down.”
The universally stated danger of using biologics is the possibility that your immune system might be less able to fight infection. This is because the T-cells that summon other white cells to do battle with imaginary foe where P-lesions happen, are the same T-cells that summon other white cells to do battle with REAL foe that can cause infection. If those T-cells become TOO suppressed (or their communications capability is too confounded by the biologic) it would be that much easier for an infection to take hold.
This appears to have happened to me in late October. A tiny scalp laceration quickly developed into a cyst-like body that kept enlarging. It was about the size of the outermost joint of my thumb, and it was inflamed, hurting, and affecting my hearing when I finally went to an Urgent Treatment Center on a Saturday. They lanced the thing, partially drained it and stuffed it with gauze, prescribed an antibiotic and sent me home with instructions to return. The culture they took revealed that I had a staph infection. Though I was due for another shot of Humira the following Tuesday, I didn’t take it.
Would this have happened had I not been taking Humira — or a double dose of Humira? Impossible to say, I suppose, but it is interesting to note that of all the nicks and scratches my scalp has endured over the past 5 decades, this is the first time this has happened. I think the healthy thing to believe is that the Humira did make it possible for the staph to take hold where it might not of, otherwise. I must be more careful!
FlakeHQ’s poet laureate, Sherry Sheehan, has been anthologized in a book of poetry produced by “First Tuesday,” a group of poets who gather monthly at the Benicia Public Library in northern California to read their work to each other and guests. The book, Every First Tuesday | An Anthology of the Benicia Library Poets, was conceived and produced by the group — and they’ve done a superlative job. Every First Tuesday is a pleasure to hold and to read.
Sherry S. is one of 31 poetry contributors to the anthology. Her four poems — “Crockett Elixiration,” “Cow Consciousness,” “Carquinez Waterfront Lunch” and “Leaving Sweet City” have a familiar wit and word play about them, but they don’t feature P and they show a breadth to Sherry’s brush that we’ve not experienced, here. “Carquinez Waterfront” is my favorite. It’s a classically structured poem (both rhyme and scan) and, at the same time, a fresh morsel of sensuality. Me thinks Sherry S. is a timeless romantic!
If you would like a copy of Every First Tuesday, email [email protected] (Benicia's poet laureate and member of the group) for instructions.
Speaking of Sherry S.... Back from Hawaii she gives us a Halloween offering from the Islands, and she’s in rare form. One cannot understand psoriasis and read “Costumed” without laughing.
Our year’s-end Trace story is, well, seasonal, if that character we’re getting to know as Trace can ever really be seasonal. Enjoy Rodger Jacobs’ “Trace and the Christmas Shoppers.”
And a first poem from a poet new to FlakeHQ: Vix brings us Ode to my Skin.
Click on the “send mail” anywhere inside FlakeHQ and your email program will automatically incorporate the new address for me in a new message form. It won't, however, update your address book! Sometime in the "near future," the adelphia.net address won't work at all. My local cable company, also my Internet service provider, has been purchased by Times Warner Cable and they are shifting all of us to their email system, Roadrunner. The "[email protected]" address, however, will not be subject to the whims of my local ISP.
Happy Holidays all!