Health Do you have a problem youd like answered? If so, write to us at: Inspire magazine, 1 Cambridge Technopark, Newmarket Road, Cambridge CB5 8PB or email inspire@arthritiscare.org.uk Ask the doctor Whether its a health niggle or emotional problem, Inspires dr sarah Jarvis gets straight to the point Q i have been having enbrel injections for some time and am due to have a foot operation. im not sure if its safe to accept a cancellation, as i thought ineeded to stop it for two weeks before surgery. name and address withheld dr sarah Jarvis answers: Enbrel, or Etanercept, is one of the anti-TNF drugs that are part of the biologics family. Tumour necrosis factor (TNF) is released by your body as part of the process of inflammation and, at high levels, can cause damage to joints. People with rheumatoid arthritis and other inflammatory conditions such as psoriatic arthritis tend to have very high levels of TNF in their bodies. As well as Enbrel, there are four other anti-TNF drugs licensed in the UK: infliximab (Remicade), adalimumab (Humira), certolizumab pegol (Cimzia) and golimumab (Simponi). They work in slightly different ways, but all reduce the levels of TNF in your system. Under normal circumstances, TNF acts as part of the immune system, stopping viruses from multiplying and helping to fight off infection. Consequently, reducing levels of TNF with medication increases your risk of infections. Around one in 50 people taking Enbrel will get a serious infection every year. If you have other longterm conditions, such as diabetes, this risk could be higher. Clearly, every operation carries arisk of infection. For this reason, its usually advised that you stop Enbrel before surgery and for some time after. I have seen different recommendations for the length of time, ranging from nine to 14 days before surgery and from two weeks after surgery, until the wound is healed. Of course, if you needed emergency surgery this wouldnt be possible, but it does increase the risk of serious infection after surgery. I would suggest you speak to your rheumatologist, who will know the specifics of your case and advise you on the risks. They may recommend, for instance, accepting a cancellation at seven to 10 days notice, but not less. Ask the expert guy Brain is from Arthritis Cares Helpline team. You can call the Helpline free on 0808 800 4050 Q i really want to make a fresh start with my osteoarthritis. have you got any suggestions? last year i had a lot of stiffness in my back, put on a bit of weight and was not sleeping well. my main arthritis is in my knees and i manage that reasonably well. amanda, 55, librarian guy Brain answers: Im sorry to hear that you have been having problems with your back and your sleep. Its well known that disturbed sleep can end up having an impact on eating and body weight. The good news is that there are some really great sources ofinformation about healthy life choices, where the emphasis is on enjoyment and positive options. Our booklet Healthy Eating and Arthritis presents information andrecipes that readers really like. Its good to know that healthy food can bean option even if you are having atired day, or are in a rush. You might like to ring our Helpline team for a chat about your arthritis. It can be helpful to talk about issues such as managing pain, and you could get some tips on relaxation and sleep. One thing that your GP might be able to help with is a physiotherapy referral, because your daily stretches and moves might need to be adapted to help your back. Have you seen our factsheet on back pain? Our Helpline can post you more information if youd like. If youd like to speak to someone about arthritis, call our Helpline team on 0808 800 4050. For healthy eating advice, and more tips on living well with arthritis, click here or ask our Helpline team to post a booklet out to you.