Tag: medication

Friday, July 17th, 2009

Methotrexate for Rheumatoid Arthritis: Long Term Use Considered Safe

The results of a recent study published in the Annals of the Rheumatic Diseases indicate that the drug methotrexate (MTX) appears to be safe for long term treatment of rheumatoid arthritis.  This conclusion was based on data collected from 88 studies that involved patients treated with methotrexate for at least 2 years.mtx 001

Methotrexate is classified as a disease-modifying anti-rheumatic drug also known as a DMARD.  Methotrexate had been used to treat psoriasis and cancer prior to its approval by the U.S. Food & Drug Administration in 1988 to treat rheumatoid arthritis. It is also used to treat other autoimmune diseases including ankylosing spondylitis, psoriatic arthriis, lupus and vasculitis. It can take from 6 to 12 weeks to feel the full effect of this medication.  Taken once weekly via either 2.5 mg tablets or self injection,  methotrexate blocks certain enzymes that affects the production of folic acid which is necessary for growing cells. Therefore it is necessary to take folic acid suppliments while on methotrexate.

It is important to avoid drinking alcohol while using this medication because of the increased risk of liver damage.  Methotrexate can cause abnormal liver function so it is necessary to have blood work monitoring done every 8 weeks. The 88 studies concluded that 13% of people taking methotrexate experienced elevated liver enzymes however only 3.7% had to stop using the drug due to liver toxicity. Other side effects include nausea, vomiting ( may be based on the dosage), mouth sores, rash, diarrhea, blood count abnormalities,  persistent dry cough, unexplained shortness of breath, cirrhosis of the liver ( rarely), gradual hair loss, and sensitivity to sunlight.  Some over the counter and prescription medications may increase the toxicity of methotrexate so it is important to check with your doctor or pharmacist before taking any additional medication. Methotrexate can cause birth defects and can cause complications during pregnancy.  It should not be taken if you plan on starting a family.

Patients in the study experienced side effects but usually mild. Methotrexate rates of discontinuation were less than gold, sulfasalazine and penicillamine but more than plaquenil in this study.

Of the 88 studies only 2 assessed the relationship between methotrexate and cardiovascular disease. One study concluded that there was no increased risk of cardiovascular disease, the other suggested that there may be a reduced risk.  There was no increased risk of infections linked to methotrexate.

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Thursday, July 9th, 2009

The Swine Flu (H1N1) At My House

I had planned on doing an update on any news regarding the swine flu for a while now.  I planned on keeping up to date on the spread of the virus and certainly a reminder update when it got closer to flu season for those of us in the Northern Hemisphere.  What I hadn’t planned on was the swine flu hitting my home so soon.  As of the writing of this post we have been dealing with the swine flu for 10 days now.  This morning’’s paper announced that another Rhode Islander has fallen victim to this virus.  We are told that she had an “underlying medical condition”.

Late Sunday afternoon a week ago my 9 year old son Kevin started to get quiet.  He was just not is usual bubbly self.  He is normally a very active chatty boy.  My little firecracker.  He started slow down quite a bit and I even found him sound asleep in the middle of the day.  Not at all like my Kevin.  My motherly instinct new that something wasn’t right.  As the day wore on he seemed to lose his appetite and was way too quiet.  His color was off, he looked pale to me.

Later Sunday evening I went in to check on him and he felt really worm.  I took his temperature and it read 104.  Not a number I am comfortable with, but Kevin is my third child and I have seen dozens of times when one of the kids would spike a temperature only to have it go back down 24 hours later with no explaination.  I knew what I needed to do.  I gave him some ibuprofen and put a cold compress on him and gave him plenty of fluids.   The ibuprofen seemed to bring the temperature down but only down to 100.2.  I knew then it would be a long night.  Every hour I checked his temperature, made sure that I kept a cool compress on him and watched and naturally worried.  He seemed to be out of it the next morning, but then again Mom had been into bother him many times the night before.

First thing the next morning I started asking questions, Does anything hurt? Do you feel achy?  Do you have a head ache?   He said no he just felt cold.   I suspected  that was his fever that was making him feel cold.  I continued to monitor him and by the end of the day his fever seemed to have broken and I thought it was just one of those 24 hour things that kids get.

Boy o boy was I wrong .

The next few days he had no fever or aches or pains just coughing and coughing and more coughing, post nasal drip and stuffy head. Night after night coughing all night long.  He had no appetite but I was grateful that he was drinking plenty of fluids.   Although I was not happy about his cough I was not overly concerned by it either.  I gave him some cough medicine.  I thought that he had caught a summer cold.

Then late Thursday evening he started with another fever.  This time the fever was only 102.  I knew at this point it was neither just a cold nor a 24 hour thing.  He needed to see a doctor.  This thing was not getting better on its own and now he’s got fever number 2.  The first thing Friday morning I called the pediatrician’s office.  We were lucky and got a 10:00am appointment.  On the way there Kevin starts telling me how much better he is feeling. I still wanted the doctor to take a look at him.

We got into to see the doctor and after a thorough check up he announces that Kevin has all the symptoms of the swine flu.  He tells me that he is  seeing a dozen cases every day and they all seem to follow the same pattern. Initially a really high temperature that seems to pass after about 24 hours followed by cold like symptoms and then a secondary fever with contiunuing cold like symptoms. He even had one patient in the hospital with this virus. He also tells me that the state is not testing anymore because it is too expensive for so many mild cases of this virus.  He said that the only time that the state would test is if the patient ended  up with complications that cause them to end up in the hospital.  He  then tells me that Kevin has seen the worst of it and there is really nothing to do but keep an eye on him and if he gets worse come back in, but he didn’t anticipate that happening.

I actually asked the doctor if he was sure that it was the swine flu.  I just couldn’t believe what I was hearing.  After the shock wore off I asked the doctor if I should be concerned because of the medication I take for my RA.  He suggested that I call my rheumatologist immediately which is exactly what I did.  She put me on tamiflu for ten days and wanted immediate blood work done to check on my white blood count..

While we have spent the better part of 2 weeks now coughing and sneezing with tissues galore in my house,  this was according to the doctor a really mild case of this H1N1 flu virus.  The doctor’s say that we are actually lucky to have caught this virus now when the symptoms are mild so that our bodies have the chance to build up a resistance to this virus come flu season.  I want everyone reading this to know I am very concerned how bad this will be during flu season.   If what we have experienced is mild I for one cannot imagine what severe of even a normal case of this virus is like.  When the flu vaccine is available I would suggest that everyone get it.  You do not want to get this virus.

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Friday, March 27th, 2009

What Rheumatoid Arthritis Has Taught Me: Lesson #2 Patience

RA has forced me to learn to be patient.  I have had to be patient with my medication and with my body. Patience in doctor’s offices, waiting for test results, and for prescriptions to be filled has been a difficult lesson. I wish I could say that I readily accepted the fact that my life was changing and that I would need to become a patient person to deal with all that lay ahead.  That was not the case.  I spent a lot of time just being aggravated that things took me so long to finish, or that the meds I am on were taking forever to start to work.

Some lessons come easy and some don’t.  Becoming a patient person has not been easy for me.  RA has given me no choice. It took almost 2 months before the methotrexate started giving me some relief from the pain and stiffness. The very last thing I wanted to hear from my rheumatologist was to be patient and that many RA medications can take from several weeks to several months to take the full effect.  I wanted to take a pill and be better.  Wasn’t that why I was going to the doctor in the first place?  I wanted him to make me better NOW not 2 months from now.  I don’t know why I was so dense about the whole process.  I have watched my mother for years deal with these issues.  I guess I thought I would be different.

I spent a lot of time feeling frustrated because I could not control the basics in my life.  I could no longer just finish a project in what I felt was a timely fashion.  Each project needed to be done gradually so that I would not over do things and be out of commission for several days recovering. At some point I had to accept that my body has limitations now.  I have to do things differently and that means I have to be patient. Things take longer now.  Because repetitive motions can be painful, I can do some and then I need to rest a bit.  Because staying in one postition too long can be painful, I need to sit for a while and then get up and move around.

I have chosen to be patient now and accept that my life is going on a slower path than I had planned.  I do not want to waste any more energy on something that is completely futile.  I think that somewhere along the way I had to give up trying to control things and just trust that there is a reason for all things and with patience I will understand what that is.

I think that Brian Adams put it beautifully…

“Learn the art of patience. Apply discipline to your thoughts when they become anxious over the outcome of a goal. Impatience breeds anxiety, fear, discouragement and failure. Patience creates confidence, decisiveness, and a rational outlook, which eventually leads to success.” -Brian Adams

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Saturday, March 7th, 2009

Sleep and Rheumatoid Arthritis

sleeping-oneLack of adequate sleep is a common problem for many people with rheumatoid arthritis.  Most healthy adults need 7-8 hours of uninterrupted sleep. People with RA can need up to 10 hours of rest.   There are several factors that can contribute to sleep issues for people with RA. Medications such as steroids can interfere with sleep.  Chronic pain is another common reason for insomnia. Too little sleep can weaken your immune system, increase fatigue and lower the pain threshold which increases your perception of pain. 

To improve the outlook for sleep:

  •  Set a routine; go to bed and get up at the same time each day. 
  •  Prepare your room for sleep; make sure the temperature is comfortable for sleep 
  •  Keep your room free from stimulating activities such as television, video games, or computer 
  •  Limit caffeine, alcohol, tobacco, chocolate to 6 hours prior to bedtime
  •  Try meditation to calm and center the body/mind before sleep
  •  Try milk with honey: Milk has a natural sleep inducer (tryptophan)
  •  I found myself having difficulty moving and turning  at night. What worked for me is silk pajamas.  I can move  and turn easily because the covers don’t stick to my pajamas

 

If you have tried all these things and you are still experiencing a restless night’s sleep, talk to your doctor.  It is important to communicate with you physician any difficulties that you are experiencing.

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Monday, February 23rd, 2009

RA Treatments Require Patience

purple-clockRheumatoid Arthritis has forced me, whether I like it or not, to become more patient; with myself and my medication. When you are hurting and want relief the last thing you want to hear is to be patient.  Unfortunately that is exactly what you need to do with many RA treatments.  Methotrexate (Rheumatrex, Trexall) starts to work faster than the other DMARD’s (Disease Modifying Anti-Rheumatic Drugs) in about 3 to 6 weeks.  Hydroxychloroquine (Plaquenil) originally used for the prevention of malaria can take up to 6 months to reach the full effect.  With Sulfasalazine (Azulfidine) symptom relief can take up to 3 months.  Gold (Myochrysine and Solgana) injections take 3 to 6 months before they have an effect on symptoms.  The class of drugs known as biologic DMARD (Disease Modifying Anti-Rheumatic Drugs) include Enbrel, Remicade, Humira, Kineret, and Orencia. These medications can take from several weeks to several months to achieve the full effect.  Some of these medications are taken in conjunction with one another, so that may influence the time it takes to start feeling improvement.  If you are not seeing or feeling results from your current course of treatment, discuss it with your rheumatologist. 

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  • robin: Jo-Ann, I also had this realization awhile back, ...
  • Pam: I'm glad you had this epiphany! I still get annoy...
  • Jo-Ann Colburn: I couldn't agree more with that panicky feeling. I...
  • Maria: The stillness you describe is like the moment I st...
  • Susy: Interesting research and the conclusion is a surpr...
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