Browse Questions & Answers
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What are the side effects of taking both Orencia and methotrexate? When
the methotrexate is stopped will Orencia be less effective than it would have
been before introducing the methotrexate?
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The Arthritis Society has just published an excellent pamphlet on
arthritis medications. Do ask for a copy. It will answer most of your questions
and facilitate the dialogue with your physician.
Biologics such as Orencia
are introduced generally after the patient has failed treatment with
conventional disease modifying anti-rheumatic drugs such as methotrexate. The
combination is generally more effective. Biologics increase the risk of
infections; there are interrogations about certain forms of lymph gland cancers
and concerns about lupus and multiple sclerosis. You should discuss the
risk-benefit ratio in your case with your physician. Remember that left
untreated rheumatoid arthritis can be a serious condition. After 10 years of
evolution 50% of patients are unable to work.
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Answered on: December 31, 2007 |
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I am a 19-year-old female who was recently diagnosed with seronegative
rheumatoid arthritis. I have been suffering from joint pain for a year now. It
has spread through my arms and has started affecting my ankles and knees. I have
responded to piroxicam and celebrex but not prednisone. My x-rays showed up
clean but my blood sedimentation rate is in the 40s. Have there been other cases
with these irregularities? What may have caused the steriods to
fail?
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There are two kinds of drugs used in the treatment of rheumatoid
arthritis. The first simply relieve symptoms they are NSAIDs and prednisone.
They are the medications you have received. The second are used to control the
disease: they are called DMARDs or disease modifying anti-rheumatic drugs. If
you have rheumatoid arthritis, you should see a rheumatologist to receive
further appropriate treatment to control your condition.
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Answered on: December 17, 2007 |
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I have just had a cyst removed from under my big toe joint. The pathology
shows that it is a rheumatoid nodule. I have had joint problems in my hands and
one hip. Does this mean I have rheumatoid arthritis?
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Rheumatoid nodulosis is a condition mostly seen in children where
rheumatoid nodules can exist without the accompanying arthritis. It is rare in
adults. If you have pain and swelling in your joints you should consult your
physician and perhaps see a rheumatologist.
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Answered on: December 10, 2007 |
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I'm 29 and have had gout for four years. I’ve usually experienced an
attack (flare up) once a year, for which I would drink plently of water to flush
out my system. But this year, the attack has lasted eight weeks. I’ve taken
novo-methacin and apo-allopurinol, but nothing is working. I'm very athletic,
rarely drink and have lowered my protein level dramatically. Do you have any
thoughts for others in a similar situation?
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Gout is extremely rare in people under 50 years of age and in women who
have not reached menopause. I would suggest that you first see a rheumatologist
and make sure that this is the proper diagnosis.
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Answered on: December 03, 2007 |
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I have been told that I have broken cartilage in my left hip. I am
currently awaiting surgery. The waiting time is very long. Is there anything
that I can take (vitamin or mineral) to help the repair? I am hoping that I am
able to repair it on my own before the surgery.
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Unfortunately there is nothing you can take to repair the cartilage of a
joint that has been severely damaged by degenerative arthritis. Your physician
can relieve your pain as you wait for surgery.
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Answered on: November 26, 2007 |
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I have recently discovered through a bone scan that I have
osteopenia. What is the best source of vitamin to take? What about
off-the-shelf supplements?
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Osteopenia as defined by bone densitometry is a bone density between
normal and osteoporosis.
The significance varies according to age, risk
factors and a history of fracture and thus so does the approach. This must be
determined for each patient. In patients over 50 years of age, we recommend a
calcium intake of 1000 to 1500mg daily and a vitamin D intake of 800 units
daily. The diet of most Canadians is deficient in that sense and thus, you
should ask your physician to suggest the supplements that you may need.
Weight-bearing exercise such as walking is suggested for 30 minutes daily. If
you have a history of fracture or are at risk according to age, degree of
osteopenia and other identified risks, you may need treatment with a bone
forming medication. This is to be discussed with your physician who has your
full history.
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Answered on: November 19, 2007 |
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Some people I know with rheumatoid arthritis have told me to avoid foods
like tomatoes, red meat, wine and eggplant. I can't find any information to
support this advice. I'm doubtful about this but would like some information to
back me up.
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There are a lot of myths on diet in arthritis. Do see the Canadian Daily
Dietary Recommendation. If you are on Methotrexate however, limit alcohol
consumption due to liver toxicity.
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Answered on: November 05, 2007 |
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I am almost 50 years old and have had rheumatoid arthritis (RA) for 22
years. My RA is fairly well controlled but I'm having more episodes of joint
flare ups. What is your opinion on hormone replacement therapy (HRT) treatment
for someone with RA?
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Hormone therapy is presently recommended to treat the vasomotor symptoms
(hot flashes) of early menopause. It also is helpful in the prevention of bone
loss. Rheumatoid arthritis is among the minor causes of osteoporosis. Thus,
hormone therapy may benefit bone health in these patients. The long term risks
on breast cancer must be addressed.
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Answered on: October 29, 2007 |
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I currently have extreme difficulties finding a
medication to treat my rheumatoid arthritis (RA) which does not cause an
allergic reaction or severe side effects. I have tried ibuprofen, naproxen,
methotrexate, anti-malarials, steroids and now leflunomide. I am currently
having what I am told is a rare side effect to it: worsening RA. How often do
you encounter patients that cannot take any drug you try to
give?
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I keep on trying, for there are as many risk to
not treating RA as there are to treating it, and, I tell them “We have not
yet found the proper drug for you" to give them hope as we try.
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Answered on: October 22, 2007 |
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I have been diagnosed with rheumatoid arthritis
and have been taking methotrexate for almost two years. I've read that
autoimmune disorders and immunosuppressants are common causes for early
menopause. Could I be experiencing early menopause at 38 years of
age?
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I cannot comment on your particular case but I can
state that Methotrexate, at the dosages recommended in rheumatology, is
not known to be a “common” cause of early menopause.
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Answered on: October 15, 2007 |
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After a radical prostatectomy two years ago, with
a 100% clean cure, I resumed my enbrel injections for ankylosing spondylitis.
Since then, certain test results have suggested to me that the cancer has
returned. Is there a link between the cancer recurrence and enbrel treatments?
What are my best options now?
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There is no convincing evidence, at this point,
that Anti-TNF agents increase the risk of solid tumors. Interrogations, in the
medical literature, were about a possible increased risk of lymphomas (cancer of
the lymph glands) in rheumatoid arthritis. There are other options Iin your case
which will need to be evaluated in the light of the concurrent treatment of both
diseases.
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Answered on: October 09, 2007 |
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I'm 42 and was diagnosed with lupus in the Fall of
2006. I'm managing the symptoms but I have started to get hot flashes. My doctor
said that I'm starting pre-menopause. Can lupus bring on early
menopause?
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Early menopause can occur without an evident
reason or it can be related to various factors such as certain drugs that we use
to treat lupus. You may wish to discuss this with your physician who is aware of
your particular treatment.
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Answered on: October 01, 2007 |
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I have been on methotrexate, celebrex and folic
acid. Recently, I was given plaquenil also. After I started taking the
plaquenil, I started having a tingling under the skin, and then became very
itchy. Is this a reaction to the plaquenil and if so, should I stop taking
it?
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Skin rashes may develop in 2% of patients on
Plaquenil. Consult your physician, he may substitute this medication for another
if the itching is related.
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Answered on: September 24, 2007 |
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What exactly is spinal osteophytosis? If I
undertake a management program such as physiotherapy, will this slow down the
progress of this condition?
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Osteophytes are bony spurs which can be seen at
the joint margins in osteoarthritis. We cannot prevent their development at this
time. The symptoms of osteoarthritis can be relieved through lifestyle
modifications and through various types of treatments or medications but we
cannot prevent bony spurs.
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Answered on: September 17, 2007 |
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I have had rheumatoid arthritis for 4 years
and I have developed a skin eczema. Is this normal for this disease? What can I
do to get rid of it or slow it down?
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Eczema is not a usual manifestation of Ra.
Consider seeing a dermatologist for a proper diagnosis and treatment since
psoriasis is often associated with arthritis it should be ruled
out.
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Answered on: September 04, 2007 |
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I am an artist and have developed carpal
tunnel syndrome in both my hands. My hands are quite painful right now and
interfering with my ability to sleep and work. I just want to "fix" it as
quickly as I can and get on with my life. How long I should try to treat it in
other ways before surgery might be suggested? Also, do doctors consider a
person's occupation when suggesting a treatment plan?
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Have you had an electromyogram? The decision
to go to surgery tends to be based on the severity of the compression of the
median nerve at the wrist which is documented by this test in carpal tunnel
syndrome. Conservative treatment is attempted if the compression is mild. More
severe forms are referred for surgical decompression of the nerve. Discuss your
problem and your professional difficulties with your
physician.
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Answered on: August 27, 2007 |
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Does drinking products which contain caffeine have
an impact on arthritis or the medications used to treat it?
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Among other side effects, high caffeine intake has
a negative effect on bone health and on restorative sleep. Adopting a healthy
lifestyle is very important for arthritic patients.
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Answered on: August 20, 2007 |
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Three years ago my husband was diagnosed with ankylosing
spondylitis. He has terrible neck and joint pain and daily gets bad headaches.
Can ankylosing spondylitis cause the headaches?
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Neck involvement in arthritis may trigger headaches. However,
other causes should be eliminated. Speak to your
physician.
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Answered on: August 13, 2007 |
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I've had rheumatoid arthritis for 16 years and am currently
taking plaquenil. I'm going through some testing regarding eye sight loss,
seemingly as a result of the medication. Is there a possibility that the loss
can be reversed once the medication has stopped?
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The antimalarials such as plaquenil are the least toxic of
all the the disease modifying anti-rheumatic drugs in rheumatoid arthritis. The
major toxicity is on the retina. Though I cannot comment on your particular
case, I can say that at the doses currently recommended retinal toxicity
that threatens vision is extremely uncommon (<0.2%).There should be regular
monitoring by an ophthalmologist and, should signs of toxicity appear, the
medication should be stopped to prevent permanent damage.
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Answered on: August 07, 2007 |
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