Methotrexate is the standard medication that is given one time each week to treat RA. It is felt to help symptoms and slow down potential damage. While it is a safe drug, side effects can occur that can be mild or severe. Because MTX(methotrexate) can damage the liver, it is recommended to avoid alchohol. It also can cause deformity to a fetus, so men and women need to use strict birth control while on the drug and for at least 3 months after the drug is stopped. Other rare, but serious side effects include an uncommon, but potentially life threatening inflammation of the lungs. I recommend to my patients that they stop MTX and be evaluated if they develop cough, shortness of breath or fever. Some of the other side effects include but are not limited to hair loss and nausea. All patients on MTX should take daily folic acid which may help with side effects. In addition, I offer my patients folinic acid which is a pill that can be taken 8-12 hours after MTX and may help with hair loss and other problems from the drug. Weight gain is not a common side effect of MTX and is more common with prednisone. I have used MTX for over 24 years with a good response in my practice. If you have questions about whether or not the benefits of the drug do not outweigh the potential risks, it is always reasonable to seek a second opinion with a Rheumatologist especially if the prescribing doctor is not a Rheumatologist.View Thread
RA like other chronic conditions may be associated with an increased risk of depression. If patients are depressed, I encourage my patients to be evaluated by a mental health professional such as a psychologist or psychiatrist. There are many medications that can be prescribed to help with depression. Some of these medications such as serotonin uptake inhibitors, a common class of anti depressants, may be associated with an increased risk of bleeding. NSAIDS such as ibuprofen are a common class of drugs used to treat arthritis and may also increase the risk of bleeding so caution may be needed with the combination. For my patients who are depressed, one of the tests I often order measures a patient's thyroid function. I also try to help them with their sleep and discuss ways to improve sleep with and without medication.View Thread
Yes, many patients with RA also have OA and FM. Sometimes it takes some detective work to determine if the pain is from RA versus another cause. The physical exam as well as markers of inflammation such as the ESR, CRP and the new Vectra test may be useful to help determine if pain is from RA or from OA or FMView Thread
I don't find heartburn to be a common issue with Methotrexate in my patients so I cannot say it is related but many do have gastric complaints such as nasuea. I offer my patients weekly injections that we teach them to give adminsister under the skin (sub cutaneous) instead of by pill. I think there is a new product soon to be released on the market that is already filled and ready to go.I also make sure my patients take daily folic acid and sometimes give them folinic acid(leukovorin) 8 - 12 hours after methotrexate to help with side effects.View Thread
For my patients who are interested in Tumeric, I typically recommend a product from a company called Euro Medica that has Curcumin and Boswellia, another herb. I looked into studies using Tumeric when working on my book, Natural Arthritis Treatment, but did not find much. I would be interested if you have any information on where this study that you mention was published. I appreciate your comment and interest. Best regards Dr. ZashinView Thread
Thank you for your question. If I understand what are asking, when will a person develop RA. Typically between the ages of 30-50 but it can occur in kids and elderly. The symptoms may present with the sudden onset of joint pain and swelling over a day or may be more gradual. Doctors typically will wait 6-8 weeks before considering the diagnosis but based on blood testing, they may confirm it sooner.View Thread
Rituxan (rituximab) in combination with methotrexate is indicated for the treatment of adult patients with moderately- to severely- active rheumatoid arthritis who have had an inadequate response to one or more TNF antagonist therapies.In my practice, I will consider Rituxan after failure of 2 or 3 TNF's such as Humira, Enbrel and Remicade as well as other biologics such as Orencia and Actemra. There is a new oral agent that has been recently FDA approved called Xeljanz. It may have similar effectiveness to the biologics. Your doctor can be helpful in discussing the beneftis of Rituxan versus the potential risks. Many of my patients deal with depression and other issues from their chronic disease. I often try to have them see doctors/specialists who can be of help in controlling that aspect of their illness and work together to come up with the best treatment regimen.View Thread
this is not a common side effect that I have seen in my patients but if a new symptoms comes on shortly after starting a new medication, I often have them stop it for a while and retry at a later time if the potential side effect is mild.. It would also be recommended to discuss your new issue with your treating doctor.View Thread
Whenever I switch drugs in my practice, I always have a concern that while a new drug is needed, it will not be as effective as the prior medication. That being said, it sometimes takes a little while for the new medication to kick in. It would be worthwhile for your daughter to discuss her symptoms with her treating doctor to get their thoughts.View Thread
There is a condition called Polymyalgia Rheumatica where patients complain of achiness and stiffness of their thighs and shoulder area that is worse after non activity such as sleeping and improves gets better over an hour or two of movement. If there is actual weakness, I will often refer my patients to a neurologist for evaluation.In any case, a second opinion is always useful if the cause of a problem cannot be determined.View Thread
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