More sinus/Enbrel questions

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Sharon - 05 Jan 2007 16:12 GMT

Hi!
    I'm the one who posted a few months ago asking about Enbrel rx's and
was stunned to have the first month's doses handed over a couple days after
asking for it. If you guys remember, I also reported that I had a sinus
infection that I needed to clear up.
    Guess what... the Enbrel is still tucked in the fridge, and I'm STILL
trying to get rid of the sinus infection! Ten weeks of antibiotics and a short
dose of prednisone taper didn't do it. Although, the prednisone did get rid of
a nasal polyp that was probably contributing to it. Oh, and I drink at least a
liter of water every day, so I'm definitely not dehydrated.
    A few weeks ago, my ENT scraped and suctioned me out in her office, but
couldn't do much more without putting me out cold. She told me to do twice a
day sinus rinses with saline (Neilmed is good stuff), hope for the best and
come back in a few weeks. If it's not cleared up by then, then we'll head for
the anesthesia...
    Well, this past weekend, I finally did have some drainage, but I don't
think it was all of it. I don't know what triggered it to finally start
draining, or why it stopped. I did have sinus headaches, and spent a little
time with my face on a heating pad. Do you think that helped?
    Actually, I have two main questions besides that. If I'm ever able to
clear this up and START my enbrel, is there anything I can do to help prevent
getting it again, considering that Enbrel is known to cause sinus problems?
    Also, any idea or speculation on what the link between Enbrel and sinus
infection is? It seems to me that sinus infections are caused by some blockage
in the tubes, or the cilia can't sweep the mucous out, so the cavity fills up.
It doesn't seem to have much to do with the immune system, which I know is
suppressed by the drug. What do you guys think?

- Sharon
"Gravity... is a harsh mistress!"

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spodosaurus - 05 Jan 2007 19:45 GMT

> Hi!
> I'm the one who posted a few months ago asking about Enbrel rx's and
[quoted text clipped - 6 lines]
> a nasal polyp that was probably contributing to it. Oh, and I drink at least a
> liter of water every day, so I'm definitely not dehydrated.

Only a litre? Most people should be double that. People on medication,
triple, unless kidney problems or other medical issues restrict it. I
drink 3-4 litres a day of just water. Other fluids are not counted in
this amount.

> A few weeks ago, my ENT scraped and suctioned me out in her office, but
> couldn't do much more without putting me out cold. She told me to do twice a
[quoted text clipped - 8 lines]
> clear this up and START my enbrel, is there anything I can do to help prevent
> getting it again, considering that Enbrel is known to cause sinus problems?

If you are prone to these sorts of infections, antibiotic prophylaxis
may be necessary during enbrel treatment. However, this can alter gut
and vaginal flora and contribute to other problems. Best to discuss this
with your doctor. When I use nasal sprays I wipe the outside of the
spray tip down with an alcohol swab after use. I also remove it from the
nostril before letting it refill with air for the next puff. These keep
the spray and the applicator somewhat less prone to reinfecting you with
the same bugs. Keep up the saline rinses.

Some people like to use saline washes for their sinuses where a large
(relatively) amount of liquid is held in the sinus and sloshed around,
then let out along with any materials accumulated and freed up by the
wash. I would be concerned that this might mix flora from different
parts of the nose and sinuses and contribute to further infections
rather than helping them.

> Also, any idea or speculation on what the link between Enbrel and sinus
> infection is? It seems to me that sinus infections are caused by some blockage
> in the tubes, or the cilia can't sweep the mucous out, so the cavity fills up.

It's a moist, warm, dark area that is full of flora and is constantly
getting more from the environment. Enbrel suppresses immune function and
hinders the immune response in connective tissues (like those found just
beneath the cells lining the sinuses and nasal passages). So, the immune
system cannot fight bugs effectively when they start to get out of
control in there. Blockages make the problem much worse (hence some
people using rinses/washes to free these materials up before a blockage
takes hold).

> It doesn't seem to have much to do with the immune system, which I know is
> suppressed by the drug. What do you guys think?

See above.

Regards,

Ari

> - Sharon
> "Gravity... is a harsh mistress!"

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Sharon - 08 Jan 2007 15:30 GMT

>> Hi!
>> I'm the one who posted a few months ago asking about Enbrel rx's and
[quoted text clipped - 11 lines]
> drink 3-4 litres a day of just water. Other fluids are not counted in
> this amount.

Well last year I did Weight Watchers for a while and tried to drink
more than that. I found that much more than a liter and I'm peeing every 10
minutes, literally. It's simply not practical to get up and use the bathroom
every 10 minutes during the workday. So i regulate my water intake based on my
urine output. One liter/day = urinating about every 1 - 2 hours, which is more
acceptable. Consider also that I have a desk job, so I'm not sweating alot.

> If you are prone to these sorts of infections, antibiotic prophylaxis
> may be necessary during enbrel treatment. However, this can alter gut
[quoted text clipped - 4 lines]
> the spray and the applicator somewhat less prone to reinfecting you with
> the same bugs. Keep up the saline rinses.

Ahh, good point about the proper use of nasal sprays. I'll do those
also.

> It's a moist, warm, dark area that is full of flora and is constantly
> getting more from the environment. Enbrel suppresses immune function and
[quoted text clipped - 4 lines]
> people using rinses/washes to free these materials up before a blockage
> takes hold).

Ah, ok, so it sounds like Enbrel users would be more prone to colds and
other rhino-viruii. Not just blockages, but once the viruses or whatever
actually penetrate the tissues, then you have trouble fighting the infection.
That makes sense.

- Sharon
"Gravity... is a harsh mistress!"

Reply to this Message

spodosaurus - 08 Jan 2007 16:58 GMT

> Ah, ok, so it sounds like Enbrel users would be more prone to colds and
> other rhino-viruii. Not just blockages, but once the viruses or whatever
> actually penetrate the tissues, then you have trouble fighting the infection.
> That makes sense.

Viruses may be able to get more easily out of hand, but it's bacteria
(perhaps less so fungi, which are kept in line more by neutrophils as
they don't usually replicate as rapidly...if I recall correctly that is)
and post viral bacterial infections that are the real problem. this is
especially so if there are sinus blockages that prevent proper drainage
(we evolved leaning forward on our knuckles, now that we're upright our
sinuses don't drain as well already). In order to get the immune cells
into the lamina propria (connective tissue beneath the epithelium) to
eat and kill the bacteria an immune mediated inflamatory response must
be generated. Enbrel hampers this response. So, the concentrations of
bacteria under the respiratory epithelium get larger while immune cells
are having a problem getting in there to gobble them up. That's whay a
lot of doctors don't use antibiotics alone - they also stop the enbrel.
Even normal nasal flora can get out of hand if it gets through the
epithelial barrier.

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