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Newer Treatment Alternatives Help Patients To Fight War Against Autoimmune Diseases
SINGAPORE – It began with sporadic pain in her knees and then her jaw in 2016. Three months later, Ms Nicole Chan was barely able to walk and perform tasks such as dressing herself.
She was told she had rheumatoid arthritis after visiting a specialist at Singapore General Hospital (SGH) in October that year.
Rheumatoid arthritis is an autoimmune and inflammatory disease where the patient's immune system attacks healthy cells in the body by mistake, causing pain, swelling and stiffness in the affected parts.
The pain can last for hours and affect patients' daily activities and overall well-being.
Over 600,000 people in Singapore, or about 11 per cent of the population, suffer from one of several known autoimmune diseases.
Some patients even go years without getting a proper diagnosis, but the availability of a wider range of new treatments is now proving a boon to sufferers.
Ms Chan, 33, a community manager for a non-profit organisation, was initially prescribed a combination of steroids, non-steroidal anti-inflammatory drugs and disease-modifying anti-rheumatic drugs to manage her symptoms.
But the adverse side effects she experienced resulted in a switch to Janus kinase (JAK) inhibitors in November 2019.
"I experienced severe nausea, digestive issues and hair loss. I still have PTSD (post-traumatic stress disorder) from taking methotrexate – seeing the yellow pill or the liquid triggers nausea," said Ms Chan, referring to the medication she was previously taking.
JAK inhibitors are one of the newer forms of treatment, with the drugs used for inflammatory conditions such as rheumatoid arthritis and ankylosing spondylitis.
The drug interferes with signals in the body that are thought to cause inflammation, in turn preventing joint damage by calming the overactive immune system.
"Each year, we see approximately 80 to 140 newly diagnosed patients with ankylosing spondylitis and 150 to 200 newly diagnosed patients with rheumatoid arthritis," said Dr Charmaine Wang, associate consultant for rheumatology and immunology at SGH.
She said ankylosing spondylitis, which is an inflammatory condition mainly affecting the spine, more commonly affects the younger age group, with men at higher risk than women.
Rheumatoid arthritis affects women two to three times more than men and can occur at any age but typically starts between the ages of 25 and 45.
The number of treatments available has increased with huge advancements in immunology over the last 20 years.
Currently, tofacitinib, upadacitinib and baricitinib are three JAK inhibitors that are locally approved and used in hospitals.
Ms Chan, who is currently on Xeljanz, a type of tofacitinib, said her symptoms are now almost non-existent and she is able to do light exercises.
"I do experience the symptoms sometimes, but I no longer wake up stiff. Before JAK inhibitors, my pain level would be seven or eight most days, sometimes I would be bedridden. After the treatment, it is at one or two."
Adjunct Associate Professor Manjari Lahiri, a senior consultant in the division of rheumatology at National University Hospital, said JAK inhibitors are effective in reducing symptoms and inflammation as well as slowing joint damage, either when used alone or in combination with methotrexate.
Their main advantage is a rapid onset of action, with the effect kicking in within days.
"Which drug is right for which patient depends on several factors, such as efficacy, cost, patient preference and patient profile. The final choice should always be a shared decision between the patient and the treating physician," she added.
Although there is currently no cure for conditions such as ankylosing spondylitis and rheumatoid arthritis, physicians often encourage patients to tap non-pharmacological forms of therapy such as physiotherapy and regular exercise in tandem with medicine to improve and maintain joint flexibility and overall mobility.
Ms Chan regularly visits traditional Chinese medicine physicians for meridian massages and fire cupping, which have helped to reduce ankle joint inflammation.
"There are people around fighting an invisible battle against autoimmune diseases," she said. "I hope that society as a whole will have a greater awareness of such conditions and be kind always."
I Tried AviClear—A New Laser Treatment For Acne—And It Made A Big Difference
Medically reviewed by Julia A. Siegel, MD
Dealing with stubborn acne can be a pain, so when the opportunity came up for me to try AviClear, it felt like a no-brainer. AviClear is the first FDA-approved laser for acne—it targets your oil glands to get rid of acne long-term. The breakthrough treatment is touted as an alternative to Accutane, and I was told it would clear my hormonal and stress-induced acne in just three 30-minute sessions.
I made an appointment to see celebrity cosmetic dermatologist Dr. Paul Jarrod Frank to try the treatment. Upon arriving at his office, which looks like something out of Architectural Digest, I met Jennifer Kennedy, RN, who would be performing the treatment, and Dr. Frank, who explained what I should expect from the three-session treatment. Ahead, discover everything you need to know about AviClear.
Dr. Paul Jarrod Frank is a celebrity cosmetic dermatologist and owner of PFRANKMD.
Dr. Macrene Alexiades, MD Ph.D. PLLC is a dermatologist and founder of Macrene Actives and also the lead author on the study for AviClear that attained FDA approval.
Dr. Kseniya Kobets is the director of cosmetic dermatology at Montefiore Einstein Advanced Care.
"AviClear is the first FDA-cleared laser treatment for the treatment of mild, moderate, and severe acne," says Dr. Frank. "Acne forms when sebum, the oily substance on the skin, combines with dead skin cells and clogs pores. AviClear targets acne at the source. This revolutionary laser treatment uses a 1726 nm wavelength to selectively target the sebaceous glands to damage the sebocytes and suppress sebum production," he explains.
Dr. Alexiades explains that AviClear is the first laser that is safe and effective across all skin types. "Much like Accutane, this is the only treatment where results continue to improve for months up to a year at least following the last treatment," she says. Additionally, she notes that not only does it treat active acne and prevent new acne from forming, but clinical studies have also shown improvement with acne scars.
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Benefits of AviClearReduction in breakout duration
Milder breakouts
Improvement in skin appearance
Can treat face and body acne
"After completing the treatment series, patients can expect a reduction in breakouts, as well as an overall improvement in skin appearance," Dr. Frank says. "Future breakouts will be less frequent, shorter, and milder overall." Cutera, the global aesthetics device company that created and supplies AviClear devices to aesthetic practices, recently released data on the treatment's long-lasting effects. "90% of patients had a visible improvement in their acne at 6 months, and 12-month clinical findings show this improvement increases to 92%, confirming the continual improvement of acne clearance and skin quality over time," Dr. Frank explains. The benefits of the treatment will continue for months after the third and final treatment; as time goes on, your skin will get clearer.
AviClear also helps to treat pesky monthly hormonal breakouts that many of us experience. Dr. Frank points out that the majority of his patients are in their late 20s and 30s and are tired of dealing with breakouts.
Though not as common, Dr. Frank says the benefits of AviClear can also go beyond the face. "We have had patients get their backs and chests treated, as well," he notes. "AviClear is truly the acne treatment for almost anyone, but of course, I always recommend consulting with a dermatologist to see if you are a good candidate."
How to PrepareAside from arriving at your AviClear appointment sans makeup, Dr. Kseniya Kobets, director of cosmetic dermatology at Montefiore Einstein Advanced Care, says, "Patients should avoid any procedures or skincare that would irritate or exfoliate the skin, such as peels or other lasers within the last four to six weeks."
What to ExpectTaryn Brooke
My skin before my first AviClear treatment.Though I have only had two sessions of AviClear and will return for my third and final treatment in a month, you will see significant results after your second session. After Dr. Frank explained what to expect from the treatment, he and Kennedy left the exam room while I changed into a robe. Before I sat in the procedure chair, Kennedy handed me a clear shower cap and wrapped a towel around my neck. She then proceeded to clean my face with alcohol and acetone. Dr. Kobets explains that alcohol and acetone are used because the skin needs to be degreased of oil for the laser to do its job.
Taryn Brooke
Immediately after my first AviClear treatment.The laser presses into your skin and uses AviCool, which maintains the skin's temperature throughout the treatment to minimize discomfort but doesn't prevent what Kennedy calls "spice." As she pressed the laser into my face while continuously dousing my face with water, the laser would create a snapping sensation (or "spice"). With each pulse of the laser, I could not predict whether or not I would feel the spice. I wouldn't say it was painful; instead, the unpredictability of the snap is what made me feel uncomfortable. There are certain parts of the face where you are more likely to feel the laser, for example, around your chin, cheek, and nose—the places where you are more likely to experience acne. Also, the laser can feel even spicier depending on where you are in your menstrual cycle.
As she talked me through the experience, the treatment was over before I knew it. After Kennedy was finished, she handed me a mirror so I could get a good look at my face, which after each session was not as red as I thought it would be. Then, she left to allow me to get dressed and returned with a single dose of an antibiotic to prevent inflammation and a single treatment dose of Valtrex. Though used to treat cold sores, it is given after each session as a precaution, even if you don't suffer from them, as the laser can trigger a breakout.
Before + AfterTaryn Brooke
My skin purging after the first treatment.The redness in my face quickly disappeared after the treatment. In the days following my first session, I noticed I looked slightly swollen but was completely unbothered by it. However, by day three post-AviClear, my poor face started to purge around my cheek, chin, and jawline.
"Some patients may experience skin flare-ups a few days following each treatment, but this is nothing to be worried about and does not mean the treatment isn't working," Dr. Frank explains. Though unsurprised by the purge, I felt the need to switch out my regular vitamin C serum for Skinceuticals Silymarin CF ($182) to speed up my breakout recovery.
Taryn Brooke
My skin a few weeks after the first treatment.As the weeks went on, my breakouts calmed down, and I noticed my skin looked brighter and felt smoother, and any residual dark spots from healed acne had disappeared. I did notice, though, that my skin was just a little on the drier side. After my second AviClear treatment and the days following, I did not experience an acne purge; rather, just one or two small breakouts on my chin. "The purging tends to diminish after each treatment, but each experience can be individual," Dr. Frank says. I predict I'll be completely purge-free by my third and final treatment next month.
Potential Side EffectsAviClear is safe for all skin types and has minimal to no side effects except a little post-treatment redness that dissipates within a few hours. Dr. Frank says there is no downtime with the treatment and that you can even apply makeup several hours after treatment if need be.
The CostThe average cost for three sessions of AviClear is around $3000, with each session costing around $1000. Cutera also offers monthly financing for AviClear, starting at $99 monthly. Three sessions spaced 30 days apart are recommended to see optimal results from the treatment.
AftercareDr. Alexiades recommends stopping topical medications, such as retinoids, for 2-3 days post-treatment, avoiding the sun as much as possible, and wearing sunscreen as you recover from the laser treatment. Dr. Frank also recommends waiting a year after the third treatment before considering additional treatments.
The Final TakeawayAfter two treatments, I can confidently say that AviClear delivers on its promise of clearer skin by targeting acne right at its source. After just two 30-minute sessions, I have already noticed the acne around my jawline, chin, and cheeks disappear, and I look forward to seeing my skin after my third and final treatment. With no downtime or side effects, AviClear is a must-try treatment for anyone with acne. I just wish this treatment had been available during my teenage years.
Up Next: I Tried Glacial Rx—The Newest CryoAesthetic Treatment—And My Skin Has Never Looked Better
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