A supplement to

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“RA led to my dream job”

Moves thatmake your mornings easier

Tools to get more from your next checkup

Model turned fashion designer Juretha Lawson tells how...

Compliments of your doCtor

vol. 1, no. 2

is psoriatic arthritis behind your joint pain?

3Focus on joint pain

supplement to Arthritis health monitor 3

Take back control from

RA

health monitor Network is the nation’s leading patient-education publish-ing company, with publications, including Arthritis Health Monitor, available in doctors’ offices and in homes. For more information, contact: Health monitor Network, 650 From Road, paramus, NJ 07652; 201-391-1911; healthmonitor.com ©2011 Data Centrum Communications, Inc.

This publication is not intended to provide advice on personal medical matters or to substitute for consultation with a physician.

3 Take back control from RA pain and stiffness! Find your best treatment—and your pathway to relief

5 Joint pain? Why psoriatic arthritis might be to blame Get the facts about this condition, which affects up to 30% of people with psoriasis

7 “ I found my dream job thanks to RA!” How RA inspired Juretha lawson to become a clothing designer

12 Make your mornings easier try these soothing moves before you even get out of bed!

15 How does joint pain affect your life? Fill out this worksheet and ask your doctor these questions at your next appointment

on your horizon: plenty more good days! the latest treatments will have you feeling better and more energetic than ever

A few days after giving birth to her son, Lana Barhum woke up and couldn’t move. “I was unable to walk or even wiggle my fingers,” says the now 35-year-old legal assistant from Ohio.

“I picked up the phone and called my sister and told her that I needed her,” Lana remembers. Her sis-ter wound up staying for two months. “If not for her, I am not really sure how I could have taken care of a newborn when I could barely hold a fork.”

Although she had been suffering with strange aches and pains for years, the flare after her pregnancy was definitely the worst she’d ever experienced. “After years of frustration at the lack of answers, I started to wonder if what was wrong with me was all in my head,” Lana says. “It took time but eventually the answers came.” Lana’s family doctor referred her to a rheumatologist. After a few tests, the rheumatologist confirmed she had rheu-matoid arthritis (RA), a condition that affects more than 1.3 million Americans. “I felt both happiness and defeat,”

RHeumaToID aRTHRITIs basICs

Joint pAin cAn’t keep ME down!

“I found a doc who’s as type A as me!”“it was about 10 years ago and i’d been

fighting psoriatic arthritis since high

school,” recalls Carl Brody,

42, of the first time he

met his current doctor.

“He stood very close

to me and said, ‘We’re

gonna fix you.’ A surge

of adrenaline rushed

through my body—i knew this was

someone who would be my advocate.”

during exams, Carl and his doctor would

discuss new research and medications,

ultimately leading them to biologics in

2003, a decision Carl credits for giving him

his life back. “i’m a guy who always wants

an action plan, so to feel hopeful about

the future, i needed a doctor with an

equally proactive approach.”

“I reframed my thinking!”Biologic medication

was relieving shelly spence’s rA, yet the

31-year-old from Vancouver,

WA, still put limits on

herself—until a woman

asked her to run in a

charity marathon. “ ‘i

can’t; i have rA,’ i said.

the woman’s reply: ‘But isn’t

rA the reason you should do it?’ that

question has shifted my perspective ever

since. i’ve now completed 10 marathons,

finished 100-mile bike rides and scaled mt.

Hood! there’s no limit to what i can do.”

inside

Lana says. “I was happy because I finally had an answer, but defeated because there was no cure. Here I was, 32 years old and feeling like I was 80.” Little did she know, she would soon find her road to relief.

What is RA? When you have RA, your immune system—which normally fights healthy invaders—starts attacking your joints, causing inflammation, stiffness, and the loss of cartilage and bone. Although the medical term is rheumatoid arthritis, it’s more appropriate to call it

STAFFEditor-in-Chief maria Lissandrello

Copy and Projects Manager Lindsay bosslett

Senior Art Director John angelini

Senior Graphic Designer Helene elek

Production Directorkimberly H. Vivas

Vice President, Associations and Business Development Dave Dolton

Vice President, Marketing and New Product Development alex Dong

Chief Financial Officer Ding yu

President kenneth Freirich

Chief Executive Officer eric Jensen

Reviewed by Health monitor’s arthritis expert: Elinor mody, mD—assistant professor, Harvard medical school Director, Women’s orthopedic and Joint Disease Center, brigham and Women’s Hospital, boston, ma

use juretha’s style tips to look—and feel—great!

2 focus on JoiNT PAiN

The pathway to reliefThe good news is, you don’t have to just live with the pain and inflammation of RA—and Lana is proof.

“I still work and maintain a work-home life balance, but I have learned to include my family in tasks that I used to take on alone,” she says. “There are days when I feel physically and emotionally drained. On those days, all I have to do is look at my sons and see how indepen-dent, strong and empathic they are despite RA in our lives. While my kids think they need me, they don’t realize that I need them, too.”

And Lana’s feeling pretty great these days, thanks to medication, three or four sessions of yoga a week, meditation and prayer. She’s also built a solid, trusting relationship with her doctor. She was frank about her symptoms and provided details (like what her pain felt like, what might have triggered it and what might make it feel better) that helped him determine the treatment path that made sense for her.

“I often tell fellow sufferers that they have the power to advocate for themselves,” Lana says. “They can do this by learning about their condition, expressing their needs and concerns clearly, and opening up about how the disease affects them. For me, it’s never been about coping. It’s been about thriving despite RA. That means accepting that sometimes there are things—like the physical aspects of the disease—that are out of your control, but knowing that how you respond and fight back are always in your control.”

4 focus on JoiNT PAiN supplement to Arthritis health monitor 5

Is

psoRiAtic ARthRitis behind your

Joint pAin?

rheumatoid disease, as it can affect almost every organ. Many cells play a role—and not everyone will experience problems with each type of cell. For some, T cells (white blood cells that normally help the body fight infections) or B cells (which normally produce antibodies) will go haywire and cause problems. Sometimes cytokines (proteins that normally regulate the immune system) mal-function. Various treatments take aim at problem cells.

Why does RA hurt?During an RA flare, the immune system cells listed above target your synovium—the delicate lining that surrounds and cushions your joints and produces fluid that lubricates the area. As a result, your synovium becomes swollen and inflamed, putting pressure on your nerves, which then transmit pain signals to your brain. What’s more, the swollen synovium also protrudes into the joint, where it releases chemicals that eat away at the bone.

rHeumAtoid ArtHritis BAsiCs psoriAtiC ArtHritis BAsiCs

Amanda Steyer struggled with joint pain and swelling for so much of her life, she thought it was normal. “When I was younger, doctors chalked it up

to growing pains,” says the mother of five from Bristol, CT. In addition to the joint pain, she’d been getting strange rashes on her skin, and was diagnosed with what she thought was a separate condition: psoria-sis—an autoimmune condition that causes patches of thick, red spots on the skin that burn and itch.

“Then I had a very bad flare of arthri-tis in my feet and had a lot of testing done.” Over the next 11 years, Amanda’s symptoms came and went, and she found herself too busy taking care of her fam-ily—including her five kids—to figure out why the aches and pains never seemed to go away for good. Then, one morning in February 2011, everything changed.

“I woke up and my left ankle wasn’t working. I had almost no range of motion. My primary care doctor discov-ered not only severely limited range of motion in my left ankle, but substantially limited range in my right ankle.” Her doctor eventually referred Amanda to a rheumatologist, who, after several months and many tests, diagnosed her with psoriatic arthritis (PsA).

Affecting an estimated 500,000 Americans, PsA is not as well known as other forms of arthritis, yet raising aware-ness is critical. That’s because treatments are now available to control the disease. And left untreated, PsA can cause perma-nent and irreversible joint damage.

supplement to Arthritis health monitor 5

“For me, it’s never been about coping. It’s been about thriving despite RA.”

About 30% of people with psoriasis develop psoriatic arthritis. luckily, with the right treatment plan, you can live a full and active life.

Gentle exercise, like walking, helps keep joints limber and reduces pain,

according to a study in Arthritis &

Rheumatism.

6 focus on JoiNT PAiN supplement to Arthritis health monitor 7

What is PsA? About 30% of people with psoriasis eventually develop PsA, according to the National Psoriasis Foundation. Psoriasis is an autoimmune disease that causes scaly skin patches that itch and burn, while PsA is an autoimmune disease that causes joint pain. Turns out, the same miscommunication between cells that causes scaly patches to form on the skin can also cause joint damage, bringing with it pain in fingers, wrists, knees, hips, ankles, toes, spine and other joints.

Most people with PsA develop psoriasis first— sometimes as early as 10 years before—and then develop psoriatic arthritis. But sometimes the joint problems begin before skin lesions appear, which can delay diagnosis.

Could you have PsA?If you have joint pain, a careful evaluation by a rheumatol-ogist can help you determine the cause. In PsA, a “sausage-like” swelling of the fingers and toes often accompanies the pain. It’s also common to have problems with your nails—they may start to separate from the nail bed, or develop small depressions on their surface. Morning stiffness and fatigue are also signs of the illness. In addition to having psoriasis, several factors can increase your risk, including: Having psoriatic lesions on your nails Having a parent or a sibling with the disease Being between ages 30 and 50. Although people of any age can develop psoriatic arthritis, it occurs most often during those years.

psoriAtiC ArtHritis BAsiCs

What you can doIf your doctor diagnoses you with PsA, take heart: Many of today’s medical options can treat both the psoriasis and the psoriatic arthritis. Talk to your doctor about trying one of the many medications available, such as: NoNsteroidal aNti-iNflammatory drugs (Nsaids) & corticosteroids These can ease pain, inflammation and stiffness, but don’t prevent joint damage.

systemic “body-wide” medicatioNs These help relieve symptoms and can limit joint damage.

biologics These medications, such as TNF-alpha inhibitors, block a protein called tumor necrosis factor (TNF) that causes inflammation. Biologics can help prevent further joint damage.

Relief is possible!Amanda isn’t letting PsA bring her down. In addition to homeschooling and raising her five children with her husband, Jim, she also provides child care for friends and neighbors, and is the cofounder and president of Mindful Village (fclct.org), a nonprofit organization that provides an online community for parents.

“For me, humor is the best coping skill,” Amanda says. “My kids help a lot with that aspect of ‘Sporadic Artie,’ as we refer to ‘him,’ thanks to my 3-year-old who can’t quite wrap her mouth around ‘psoriatic arthritis.’

“Having lots of little kids in the house is also a helpful coping skill—they keep my joints moving, but also allow for a nice balance of cuddling and reading time. During times my body is acting up, I don’t always mind laying there to read them their favorite book over and over and over again so I don’t have to move!”

What’s also helped Amanda is staying in touch with her doctors to make sure she is up-to-date on her tests and to get answers to any questions she might have. “I found doctors who took the time to really get to know me and discuss things fully with me, and whom I can contact just about any time of day. My rheumatologist has even called me from home to discuss test results!”

Amanda also chose to “make friends” with PsA instead of fighting with it. “PsA has allowed me to get to the heart of what’s really important and let go of the rest. It has encouraged me to slow down and enjoy the beauty around me, and it’s taught me to see the world through my blessings instead of my hardships.”

CoVer story

watching Juretha Lawson pose for the camera, you’d never guess she has rheumatoid arthritis (RA). At 57, she exudes serenity and style and has a long, lean figure women half her age would envy. Her secret? “I eat right, exercise and am lucky that

medication keeps my RA symptoms in check.”But things weren’t always so rosy for the model, entrepreneur

and former schoolteacher from Chicago. “Around my 50th birthday, I began experiencing mysterious pains and unrelenting fatigue,” she recalls. “I canceled on friends, skipped parties and watched my social life go from vibrant to nonexistent. I assumed it was menopause until one morning I woke up unable to stand. The bottoms of my feet were so tender I couldn’t put weight on them, never mind walk across the room.” With a scarf tied around her neck and arm to stabilize a throbbing shoulder, Juretha made it to see her doctor. “Looking back, it was crazy that I drove myself—I could barely steer the car—but I was desperate for relief.” Luckily, relief came quickly once she was diagnosed with RA. “After I started on my medications, I felt much better, and improved more each day.”

Juretha did lots of research and found out about what she should eat and what were the best exer-cises for RA. The one thing she couldn’t find were clothes that fit her new life. “I wanted piec-es without zippers and but-tons so they were easy to put on and take off if my hands swelled up. And they need-ed to be ultra-soft, wrinkle-

by Katie Alberts

“RA opened the door to my dream career!”

supplement to Arthritis health monitor 7

“For me, humor is the best coping skill”

Phil MickelsonChampion golferENBREL psoriatic arthritis patient

If you have psoriatic arthritis or moderate to severe rheumatoid arthritis

“Don’t let joint pain keep you from the things that matter most.”

ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with psoriatic arthritis. ENBREL can be used in combination with methotrexate in patients who do not respond adequately to methotrexate alone.

ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with moderate to severe rheumatoid arthritis. ENBREL can be taken with methotrexate or used alone.

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about ENBREL?ENBREL is a medicine that affects your immune system. ENBREL can lower the ability of your immune system

to fight infections. Serious infections have happened in patients taking ENBREL. These infections include tuberculosis (TB) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some patients have died from these infections. Your doctor should test you for TB before you take ENBREL and monitor you closely for TB before, during, and after ENBREL treatment, even if you have tested negative for TB.

There have been some cases of unusual cancers reported in children and teenage patients who started using tumor necrosis factor (TNF) blockers before 18 years of age. Also, for children, teenagers, and adults taking TNF blockers, including ENBREL, the chances of getting lymphoma or other cancers may increase. Patients with RA or psoriasis may be more likely to get lymphoma.

Before starting ENBREL, tell your doctor if you:• Have any existing medical conditions

• Are taking any medicines, including herbals

• Think you have, are being treated for, have signs of, or are prone to infection. You should not start taking ENBREL if you have any kind of infection, unless your doctor says it is okay

• Have any open cuts or sores

• Have diabetes, HIV, or a weak immune system

• Have TB or have been in close contact with someone who has had TB

• Were born in, lived in, or traveled to countries where there is more risk for getting TB. Ask your doctor if you are not sure

• Live, have lived in, or traveled to certain parts of the country (such as, the Ohio and Mississippi River valleys, or the Southwest) where there is a greater risk for certain kinds of fungal infections, such as histoplasmosis.

These infections may develop or become more severe if you take ENBREL. If you don’t know if these infections are common in the areas you’ve been to, ask your doctor

• Have or have had hepatitis B

• Have or have had heart failure

• Develop symptoms such as persistent fever, bruising, bleeding, or paleness while taking ENBREL

• Use the medicine Kineret® (anakinra), Orencia® (abatacept), or Cytoxan® (cyclophosphamide)

• Are taking anti-diabetic medicines

• Have, have had, or develop a serious nervous disorder, seizures, any numbness or tingling, or a disease that affects your nervous system such as multiple sclerosis or Guillain-Barré syndrome

• Are scheduled to have surgery

• Have recently received or are scheduled for any vaccines. All vaccines should be brought up-to-date before starting ENBREL. Patients taking ENBREL should not receive live vaccines.

• Are allergic to rubber or latex

• Are pregnant, planning to become pregnant, or breastfeeding

• Have been around someone with chicken pox

What are the possible side effects of ENBREL?ENBREL can cause serious side effects including: New infections or worsening of infections you already have; hepatitis B can become active if you already have had it; nervous system problems, such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes; blood problems (some fatal); new or worsening heart failure; new or worsening psoriasis; allergic reactions;

autoimmune reactions, including a lupus-like syndrome and autoimmune hepatitis.

Common side effects include: Injection site reactions, upper respiratory infections (sinus infections), and headache. These are not all the side effects with ENBREL. Tell your doctor about any side effect that bothers you or does not go away.

If you have any questions about this information, be sure to discuss them with your doctor. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see accompanying Medication Guideon the next page.

©2011 Amgen, Inc., Thousand Oaks, CA 91320 and Pfizer Inc. All rights reserved. MC52324-A-1 03-11

Ask your rheumatologist if ENBREL may be right for you, if you have joint pain, stiffness, or swelling, and think you may have psoriatic arthritis or RA.

Call 1-888-4ENBREL or visit www.enbrel.com. Prescription ENBREL is taken by injection.

ENBREL is the #1 prescribed biologic by rheumatologists. ENBREL is also

approved for adults with moderate to severe rheumatoid arthritis (RA). At six months, ENBREL

was shown to be effective in about 50% of psoriatic arthritis patients who used it.

“ In the summer of 2010, I experienced intense joint pain and had trouble walking. My rheumatologist diagnosed me with psoriatic arthritis and prescribed ENBREL, a medicine that can relieve pain and stiffness, improve physical function, and help stop joint damage from worsening. Now I’m back to doing the things I love.”

Your results may vary.

635-25283

Bleed: 16.25” x 11.125”Trim: 15” x 10.5”Live: 14.5” x 9.5”

CLIENT NAME: Abelson Taylor JOB#: VW185DESC: Enbrel

OPERATOR: DLROUND: 1DATE: 03/31/2011

FILE NAME: VW185_a01.indd QC Check

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supplement to Arthritis health monitor 11 ©2010 Amgen Inc., Thousand Oaks, CA 91320 and P�zer Inc. All rights reserved.

Medication Guide Enbrel® (en-brel) (etanercept)

Read the Medication Guide that comes with Enbrel before you start using it and each time you get a refill. There may be new information. This Medication Guide does not take the place of talking with your doctor about your medical condition or treatment. It is important to remain under your doctor’s care while using Enbrel.Enbrel is a prescription medicine called a Tumor Necrosis Factor (TNF) blocker that affects your immune system.What is the most important information I should know about Enbrel? Enbrel may cause serious side effects, including:1. Risk of infectionEnbrel can lower the ability of your immune system to fight infections. Some people have serious infections while taking Enbrel. These infections include tuberculosis (TB), and infections caused by viruses, fungi, or bacteria that spread throughout their body. Some people have died from these infections.• Your doctor should test you for TB before starting Enbrel.• Your doctor should monitor you closely for symptoms of TB during

treatment with Enbrel even if you tested negative for TB.• Your doctor should check you for symptoms of any type of infection

before, during, and after your treatment with Enbrel.You should not start taking Enbrel if you have any kind of infection unless your doctor says it is okay.2. Risk of cancer• There have been cases of unusual cancers in children and teenage

patients who started using TNF-blocking agents at less than 18 years of age.

• For children, teenagers, and adults taking TNF-blocker medicines, including Enbrel, the chances of getting lymphoma or other cancers may increase.

• People with rheumatoid arthritis or psoriasis, especially those with very active disease, may be more likely to get lymphoma.

Before starting Enbrel, be sure to talk to your doctor:Enbrel may not be right for you. Before starting Enbrel, tell your doctor about all of your medical conditions, including:Infections – tell your doctor if you:• have an infection. (See “What is the most important information

I should know about Enbrel?”)• are being treated for an infection.• think you have an infection.• have symptoms of an infection such as fever, sweats or chills, cough

or flu-like symptoms, shortness of breath, blood in your phlegm, weight loss, muscle aches, warm, red, or painful areas on your skin, sores on your body, diarrhea or stomach pain, burning when you urinate or urinating more often than normal, and feel very tired.

• have any open cuts on your body.• get a lot of infections or have infections that keep coming back.• have diabetes, HIV, or a weak immune system. People with these

conditions have a higher chance for infections.• have TB, or have been in close contact with someone with TB.• were born in, lived in, or traveled to countries where there is a risk for

getting TB. Ask your doctor if you are not sure.• live, have lived in, or traveled to certain parts of the country (such as the

Ohio and Mississippi River valleys, or the Southwest) where there is a greater risk for getting certain kinds of fungal infections (histoplasmosis, coccidioidomycosis, blastomycosis). These infections may happen or become more severe if you use Enbrel. Ask your doctor if you do not know if you live or have lived in an area where these infections are common.

• have or have had hepatitis B.Also, BEFORE starting Enbrel, tell your doctor:• About all the medicines you take including prescription

and nonprescription medicines, vitamins and herbal supplements including:

✓ Orencia® (abatacept) or Kineret® (anakinra). You have a higher chance for serious infections when taking Enbrel with Orencia® or Kineret®.

✓ Cyclophosphamide (Cytoxan®). You may have a higher chance for getting certain cancers when taking Enbrel with cyclophosphamide.

✓ Anti-diabetic Medicines. If you have diabetes and are taking medication to control your diabetes, your doctor may decide you need less anti-diabetic medicine while taking Enbrel.

Keep a list of all your medications with you to show your doctor and pharmacist each time you get a new medicine. Ask your doctor if you are not sure if your medicine is one listed above.Other important medical information you should tell your doctor BEFORE starting Enbrel, includes if you:

• have or had a nervous system problem such as multiple sclerosis or Guillain-Barré syndrome.

• have or had heart failure.• are scheduled to have surgery.• have recently received or are scheduled to receive a vaccine. ✓ all vaccines should be brought up-to-date before starting Enbrel. ✓ people taking Enbrel should not receive live vaccines. ✓ ask your doctor if you are not sure if you received a live vaccine.• are allergic to rubber or latex. ✓ the needle covers on the single-use prefilled syringes and the

single-use prefilled SureClick® autoinjectors contains dry natural rubber.

• have been around someone with varicella zoster (chicken pox).• are pregnant or plan to become pregnant. It is not known if Enbrel will

harm your unborn baby. ✓ Pregnancy Registry: Amgen has a registry for pregnant women

who take Enbrel. The purpose of this registry is to check the health of the pregnant mother and her child. Talk to your doctor if you are pregnant and contact the registry at 1-877-311-8972.

• are breastfeeding or plan to breastfeed. It is not known if Enbrel passes into your breast milk. You and your doctor should decide if you will take Enbrel or breast feed. You should not do both.

See the section “What are the possible side effects of Enbrel?” below for more information.What is Enbrel?Enbrel is a prescription medicine called a Tumor Necrosis Factor (TNF) blocker.Enbrel is used to treat:• moderately to severely active rheumatoid arthritis (RA). Enbrel can

be used alone or with a medicine called methotrexate.• psoriatic arthritis. Enbrel can be used alone or with methotrexate.• ankylosing spondylitis (AS).• chronic moderate to severe plaque psoriasis in adults ages

18 years and older.• moderately to severely active polyarticular juvenile idiopathic

arthritis (JIA) in children ages 2 years and older.You may continue to use other medicines that help treat your condition while taking Enbrel, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and prescription steroids, as recommended by your doctor.Enbrel can help reduce joint damage and the signs and symptoms of the above mentioned diseases. People with these diseases have too much of a protein called tumor necrosis factor (TNF), which is made by your immune system. Enbrel can reduce the effect of TNF in the body and block the damage that too much TNF can cause, but it can also lower the ability of your immune system to fight infections. See “What is the most important information I should know about Enbrel?” and “What are the possible side effects of Enbrel?”

Who should not use Enbrel?Do not use Enbrel if you:• have an infection that has spread through your body (sepsis).

How should I use Enbrel?• Enbrel is given as an injection under the skin (subcutaneous or SC).• If your doctor decides that you or a caregiver can give the injections of

Enbrel at home, you or your caregiver should receive training on the right way to prepare and inject Enbrel. Do not try to inject Enbrel until you have been shown the right way by your doctor or nurse.

• Enbrel is available in the forms listed below. Your doctor will prescribe the type that is best for you.

° Single-use Prefilled Syringe ° Single-use Prefilled SureClick Autoinjector ° Multiple-use Vial• See the detailed “Patient Instructions for Use” with this Medication

Guide for instructions about the right way to store, prepare, and give your Enbrel injections at home.

• Your doctor will tell you how often you should use Enbrel. Do not miss any doses of Enbrel. If you forget to use Enbrel, inject your dose as soon as you remember. Then, take your next dose at your regular(ly) scheduled time. In case you are not sure when to inject Enbrel, call your doctor or pharmacist. Do not use Enbrel more often than as directed by your doctor.

• Your child’s dose of Enbrel depends on his or her weight. Your child’s doctor will tell you which form of Enbrel to use and how much to give your child.

What are the possible side effects of Enbrel?Enbrel can cause serious side effects, including:See “What is the most important information I should know about Enbrel?”• Infections. Enbrel can make you more likely to get infections or make

any infection that you have worse. Call your doctor right away if you have any symptoms of an infection. See “Before starting Enbrel, be sure to talk to your doctor” for a list of symptoms of infection.

• Hepatitis B infection in people who carry the virus in their blood. If you are a carrier of the hepatitis B virus (a virus that affects the liver),

the virus can become active while you use Enbrel. Your doctor may do a blood test before you start treatment with Enbrel and while you use Enbrel.

• Nervous system problems. Rarely, people who use TNF-blocker medicines have developed nervous system problems such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes. Tell your doctor right away if you get any of these symptoms: numbness or tingling in any part of your body, vision changes, weakness in your arms and legs, and dizziness.

• Blood problems. Low blood counts have been seen with other TNF-blocker medicines. Your body may not make enough of the blood cells that help fight infections or help stop bleeding. Symptoms include fever, bruising or bleeding very easily, or looking pale.

• Heart failure including new heart failure or worsening of heart failure you already have. New or worse heart failure can happen in people who use TNF-blocker medicines like Enbrel. If you have heart failure your condition should be watched closely while you take Enbrel. Call your doctor right away if you get new or worsening symptoms of heart failure while taking Enbrel, such as shortness of breath or swelling of your lower legs or feet.

• Psoriasis. Some people using Enbrel developed new psoriasis or worsening of psoriasis they already had. Tell your doctor if you develop red scaly patches or raised bumps that may be filled with pus. Your doctor may decide to stop your treatment with Enbrel.

• Allergic reactions. Allergic reactions can happen to people who use TNF-blocker medicines. Call your doctor right away if you have any symptoms of an allergic reaction. Symptoms of an allergic reaction include a severe rash, a swollen face, or trouble breathing.

• Autoimmune reactions, including: ✓ Lupus-like syndrome. Symptoms include a rash on your face

and arms that gets worse in the sun. Tell your doctor if you have this symptom. Symptoms may go away when you stop using Enbrel.

✓ Autoimmune hepatitis. Liver problems can happen in people who use TNF-blocker medicines, including Enbrel. These problems can lead to liver failure and death. Call your doctor right away if you have any of these symptoms: feel very tired, skin or eyes look yellow, poor appetite or vomiting, pain on the right side of your stomach (abdomen).

Common side effects of Enbrel include:• Injection site reactions such as redness, swelling, itching, or pain.

These symptoms usually go away within 3 to 5 days. If you have pain, redness, or swelling around the injection site that doesn’t go away or gets worse, call your doctor.

• Upper respiratory infections (sinus infections).• Headache.These are not all the side effects with Enbrel. Tell your doctor about any side effect that bothers you or does not go away.Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.How should I store Enbrel?• Store Enbrel in the refrigerator at 36° to 46°F (2° to 8°C).• Do not freeze.• Do not shake.• Keep Enbrel in the original carton to protect from light.• Keep Enbrel and all medicines out of the reach of children.General Information about EnbrelMedicines are sometimes prescribed for purposes not mentioned in a Medication Guide. Do not use Enbrel for a condition for which it was not prescribed. Do not give Enbrel to other people, even if they have the same condition. It may harm them.This Medication Guide summarizes the most important information about Enbrel. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about Enbrel that was written for healthcare professionals. For more information call, 1-888-4ENBREL (1-888-436-2735).What are the ingredients in Enbrel? Single-use Prefilled Syringe and the Single-use Prefilled SureClick Autoinjector:Active Ingredient: etanerceptInactive Ingredients: sucrose, sodium chloride, L-arginine hydrochloride and sodium phosphateMultiple-use Vial:Active Ingredient: etanerceptInactive Ingredients: mannitol, sucrose, tromethaminev5

Issue Date: 10/2010

This Medication Guide has been approved by the US Food and Drug Administration.

© 1998–2010 Immunex Corporation. All rights reserved. Printed in the USA

635-25283

Bleed: 16.25” x 11.125”Trim: 15” x 10.5”Live: 14.5” x 9.5”

CLIENT NAME: Abelson Taylor JOB#: VW185DESC: Enbrel

OPERATOR: DLROUND: 1DATE: 03/31/2011

FILE NAME: VW185_b01.indd QC Check

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free and, above all, flattering—outfits I could proudly wear to a photo shoot.” So Juretha set out to design her own line: Juretha Chic & Classic Comfort Wear. “I started working with pattern-makers and manufacturers to get all the details just right and shared my idea on Facebook. Turns out many women with RA had the same wardrobe wishes I did!”

Next on the horizon? Juretha plans to expand her busi-ness to accessories. “If it hadn’t been for my diagnosis, I never would have discovered my talents as a designer—I joke that all my clothes should have a silver lining!”

Since Juretha’s a fashion pro, we asked her to spill the style secrets that let you stay chic despite joint pain—and reveal the other ways she stays confident and healthy.

Shop for femininityand functionality”It is possible to dress stylishly and comfortably even if you’re in the midst of an RA flare-up, says Juretha. “Drawstring waists can be chic when they’re covered with a fabric sash. Pants with wide, pull-on legs drape beautifully if they aren’t too bulky at the hips. Designers are making gorgeous bracelets and rings that are elasticized so they can slip on and off swollen fingers. With so many options, there’s no reason not to look great!” Elegant no-closure tunics, dresses and pant sets, done up in luxurious neutrals and metallics, like the kind Juretha designs, are perfect for anything from work to entertaining.

Take the 15-minute fitness approach”“I know I can’t make it through an entire exercise class, but I’ve developed a habit of going to the first 15-20 minutes,” reveals Juretha. “The instructors don’t mind, and I get to enjoy the atmosphere of working out with a group.” And she has a similar strategy when it to comes to walking, her favorite type of exercise. “I’m never sure how far I’ll be able to make it on a walk, so I watch walking DVDs at home. Some days I can do half a mile, other days it’s three—and I never have to worry about having the stamina to make it back home.”

Try a ‘light touch’ massage”Like many people with autoimmune arthritis, Juretha was nervous about having someone touch her swollen joints. But it turns out massage is one of the best ways she’s found to ease pain and improve flexibility. “I started by asking my husband to carefully rub my back and feet with mentholated oil. It felt so good that I started going for monthly professional massages. The key is asking for a ‘light touch’ anywhere that might be sensitive and ‘deep tissue’ on other areas. I think of it as mix-and-match massage—and nothing makes me feel as rejuvenated!” Juretha’s experience is supported by research, which suggests that massaging RA-affected joints reduces muscle tension for days afterward.

Be direct with your doctor”“The first time I was prescribed medication for my RA, my rheumatologist said to start taking it the following morn-ing. I got home and was in so much pain that my husband suggested I call to see if I could start that night. So I called and, sure enough, my doctor said it was fine. I got a good night’s sleep, woke up feeling much better and promised myself I’d always ask whatever questions I needed to. Now my doctor and I discuss everything from my work schedule to how my skin and hair are looking.”

Set your own pace”“Running my own business has helped me manage my RA. Instead of working on someone else’s schedule, I space out my meetings and tasks to preserve my energy. I’ve also had a chance to meet wonderful people in the arthritis commu-nity and encourage their dreams. I always say, ‘If there’s a product or service you wish you’d had after your diagnosis, chances are others feel the same way, so go for it!’ ”

CoVer story

You can find more chic, comfortable clothes from Juretha’s line (which she is modeling in the photos seen here) at Juretha.com.

12 focus on JoiNT PAiN

if waking up is difficult due to pain and stiffness, you’re not alone. According to the national institutes of Health, morning stiffness is one of the most common symptoms of rheumatoid arthritis and psoriatic arthritis. to the rescue: these gentle stretches you can do before you even get out of bed!

sit tall and rest your forearms comfortably on a pillow with your palms facing downward and your hands loosely grasped in a fist.

rotate both wrists outward as you stretch all 10 fingers open. turn both hands inward and return fingers to a closed fist. repeat 15-20 rotations.

TIp! Too hard? Simply rotate wrists outward and inward without incorporating the fist contraction. Too easy? Remove the pillow and hold your elbows in the air at a 90-degree angle while doing the move.

WAke up rigHt

sit tall at the edge of the bed and cross both arms behind your head. exhale and gently tilt your head and shoulders forward and hold for 5 seconds. inhale and

carefully arch backward as you pass through the starting position and hold for an additional 5 seconds. repeat the range of motion 12-15 times.

Release your neck and back

supplement to Arthritis health monitor 13 exercises developed and modeled by Lisa Robins. photography: steven Trujillo of Trudge photo, phoenix, aZ, october 2011.

moves to make mornings easier3Lengthen your neck and shouldersLie flat on your back with your knees bent and your head comfortably relaxed on a pillow. Carefully straighten and raise your arms with your palms facing each other. While keeping your head on the pillow, exhale and reach both arms to the ceiling, allowing your shoulders to lift off the bed. hold this stretch for 30 seconds and repeat 10-15 times.

TiP! Keep your neck relaxed through the entire range of motion to allow your arms to fully lengthen both your neck and shoulder muscles.

Wake up your hands and wrists

TIp! As you shift forward and back, keep your abdomen tight to protect your lower back and strengthen your core.

check with your doctorGet your rheumatologist’s okay before starting any new exercise program!

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Getting out of bed in the morning

Getting dressed (doing buttons or zippers, tying shoelaces, etc.)

showering

Getting on and off the toilet

Reaching above my head

Reaching forward

bending down to pick something up

opening doors or cabinets

Turning lamps on and off

Turning faucets on and off

opening jars

Getting in and out of the car

Getting up or down from chairs

Doing household chores like vacuuming or dusting

Holding cups or silverware

Walking up or down stairs

Walking on flat ground

Falling or staying asleep

unable to do activities I once enjoyed (hobbies, sports, etc.)

unable to go out with friends or loved ones

unable to keep working

Feeling self-conscious about how my swollen joints look

problems created by arthritis

knowing how joint pain affects your ability to do everyday tasks helps your healthcare provider determine how well your current treatment is working. Fill out this worksheet and review it with your doctor to make sure you’re getting the best possible relief.

How does joint pain

Affect youR Life?

teAr-out tool

supplement to Arthritis health monitor 15

16 focus on JoiNT PAiN

Questions for your rheumatologist based on all my symptoms and test results, how serious is my arthritis and is it likely to get worse? ______________________________________________ ______________________________________________

How much joint damage do you think has already happened? _____________________________ ______________________________________________

What will happen to my joints over time? __________ ______________________________________________ ______________________________________________

What medications or treatments do you recommend? Can these medications prevent further damage? ________________________ ______________________________________________ ______________________________________________ ______________________________________________

How will the medication help me? What are the side effects and are they serious? _____________________ ______________________________________________ ______________________________________________

should I avoid anything while taking an Ra or psoriatic arthritis medication? ____________________ ______________________________________________ ______________________________________________

Can I stop taking my medications during a remission? ___________________________________

In addition to medical treatment, what do you suggest I do on days when I’m feeling a lot of joint pain (rest, compression, yoga, etc.) ______________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________

are there any other lifestyle changes (like diet, exercise, etc.) that you think would help my arthritis? _____________________________________________ _____________________________________________ _____________________________________________

Do you think seeing a physical or occupational therapist could help me? _______________________ _____________________________________________ _____________________________________________

When should I come back for my next appointment? _____________________________________________ Does having Ra or psoriatic arthritis raise my risk for other conditions, such as heart disease, infection or cancer? ____________________ _____________________________________________ _____________________________________________ _____________________________________________

add your own questions here: _____________________________________________ _____________________________________________

teAr-out tool