Weighing the Risks: Glenn Frey and RD Drugs

By now, just about everyone has heard the sad news about Glenn Frey, co-founder and musician/songwriter of the Eagles, the wildly popular 70s band. His untimely death on January 18 was a shock; Frey was just 67. But to learn that he’d died from complications of rheumatoid disease was another surprise--and a sobering one. An intensely private man, Frey had never spoken publicly about having it.

Complications from RA drugs

Shortly after the news of Frey’s death hit the media, his longtime manager Irving Azoff stated in an interview with TheWrap, an entertainment website, that Frey had been taking RD medications. These, he opined, were what had actually killed his old friend. “The colitis and pneumonia were side effects from all the meds,” Azoff stated. “He died from complications of ulcer and colitis after being treated with drugs for his rheumatoid arthritis, which he had for over 15 years.”

Fear in the RA community

Azoff’s statement blew up quite a storm in the RD online community. Many of us take powerful drugs for our rheumatoid disease. Designed specifically to suppress the immune system, they lower inflammation throughout the body, slow the disease’s progression, and lessens or vanishes its symptoms.

The result of Azoff’s statement was, for some people, a surge of shock and fear.

I googled a number of articles about Frey’s death. From them I learned that he’d been living with RD since around 2000. He canceled an appearance with the Eagles at the Kennedy Center Honors in November of last year because of intestinal problems (he was suffering an acute attack of ulcerative colitis, also an autoimmune disease like RD).

A statement released by the band at the time stated that Frey “...had a recurrence of previous intestinal issues, which will require major surgery and a lengthy recovery period.” But he didn’t bounce back after the surgery and was hospitalized again later in the month with pneumonia--a tragically common, frequently deadly respiratory infection that often affects ill people with weakened immune systems, the very young, and the elderly. It was the pneumonia, which also aggravated his RD and colitis that finally took his life.

The risks and benefits of RA drugs

Neither we--nor Azoff--know for sure that Frey’s RD medications were truly instrumental in his death. Nor do we know which drugs Frey took over the years to treat his disease. What we do know is this: many of the drugs we take for rheumatoid disease bring with them the possibility of side-effects in the form of infection and other complications, including cancer--which means taking them is a small, if calculated, risk.

But it’s an informed risk, too. Doctors are required to discuss the possible side-effects and dangers of these drugs with their patients before prescribing them. As patients, we have an obligation to ourselves to learn as much as we can about them, as well. Informed, we can weigh the risk of serious side effects against the potential good the drugs might do us in the form of reduced symptoms and slowed disease progression.

Living with a suppressed immune system

What are these drugs? They include the traditional DMARDs (disease modifying anti-rheumatic drugs) such as methotrexate, leflunomide, hydroxychloroquine (Plaquenil), and sulfasalazine, among others. Each of them works in their own way, but all can suppress the immune system to some degree, making it easier to get infections.

Since the turn of the century, medical science has come up with some even more powerful, genetically modified drugs known as biologic response modifiers. A component of each of them is a living protein that works in specific ways inside the body’s immune system. These may suppress the immune system even more profoundly than traditional DMARDs. The biologics include abatacept (Orencia), anakinra (Kineret), rituximab (Rituxan), tocilizumab (Actemra), adilimumab (Humira), etanercept (Enbrel), golimumab (Simponi), and infliximab (Remicade).

The immune system is our body’s amazingly efficient defense system. It fights off or destroys malevolent invading viruses and bacteria before they can take hold, do damage, or even kill us. But when we have an autoimmune disease, our gallant immune system goes haywire, mistaking the tissues it’s supposed to protect for foreign invaders, which it valiantly attacks, causing all kinds of problems.

By knocking our brave (but misguided) immune system down with DMARDs and biologics, we stop or impede its attacks, reducing the inflammation that causes so that our embattled tissues can heal. Symptoms, like swollen, painful joints and fatigue, lessen or even disappear. The RD itself slows its progression and may even go into remission, meaning that over time, it won’t do as much damage to our bones and soft tissues as it might have otherwise.

Normally, a suppressed immune system means we can catch colds or become infected more easily, and while fighting them off might take longer, we do it and bounce back eventually. But very, very rarely, it means an infection can take hold that, eventually, we might lose the fight against.

When we make the decision to take these drugs, we weigh these risks against the opportunity to live a less painful, more normal life, and to suffer less damage to our joints and soft tissues over time. We choose quality of life over pain and misery.

Just like Glenn Frey did.