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Posts Tagged ‘prednisone’

Corticosteroids or glucocorticoids are powerful anti-inflammatory drugs commonly used to treat a variety of medical conditions. They are not to be confused with anabolic steroids that are notoriously abused by athletes.1 Anabolic steroids are associated with muscle mass gain and corticosteroids are connected with metabolism and immunity.

Most every RA patient has probably taken oral steroids in the form of pills or a dose pack that tapers down the dose over a period of time. Oral steroids are effective at providing quick reduction of RAsymptoms although long-term use is generally discouraged and even short-term use is being questioned.2 When taking an oral steroid, the drug goes throughout the entire body systemically. But there are other forms of steroids that are directly injected into a specific area of the body in an effort to treat RA related symptoms. Since being diagnosed with RA, I’ve had one steroid injection into my right knee, four into my left hip, one into my neck, and one into my right elbow.

Read the rest of the post at http://rheumatoidarthritis.net/living/steroid-injections-treating-ra-symptoms/

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I’m the only male Patient Advocate and Moderator on www.rheumatoidarthritis.net and the corresponding Facebook page. There is a great page on RA and Women’s Health on our website but no corresponding page for men. Of all the people who visit the Facebook page, only 15% of the people reached were men and only 9% of the people who actively engaged by liking, sharing, or commenting on posts were men. All of this is not too surprising given the fact that the ratio of women to men with RA is about 2 to 1.[1] But with approximately 1.5 million people in the United States with RA[2], that would mean that almost half a million men suffer from RA.

When it comes to autoimmune diseases like multiple sclerosis, lupus, scleroderma, rheumatoid arthritis, and Sjogren’s syndrome, women seem to bear the brunt of these diseases in terms of proportion of people impacted. Genetics, behaviors, and hormones…

…read more at http://rheumatoidarthritis.net/living/impact-ra-men/

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It’s been three weeks since I had an anterior cervical discectomy and fusion (ACDF) surgery on vertebrae C5-C7. I outlined the procedure in an earlier post. Immediately upon coming out of surgery I could feel a positive difference in arm and shoulder pain – the site of most of the symptoms from herniated discs and bone spurs which pressed on my spinal cord and nerve roots which extend into the shoulders and arms. There have been times since surgery when I’ve experienced some finger tingling, arm pain, and shoulder spasms but that is to be expected as the surgery site recovers and the overall trend has been positive.

During ACDF surgery the neck vertebrae are expanded back to their normal distance apart after the herniated disc collapses. The disc replacement, in my case a plastic cage seeded with my own bone tissue, returns the space back to normal. I could tell things were stretched out as the muscles in my neck were tight and painful immediately following surgery. This subsided after a week or so and I can feel that these muscles are loosened up. Maybe I grew taller in the process!

neck scarIt looks like I got into a knife fight and lost (see picture) – but you should see the other guy (well, he got paid a lot of money). It’s pretty amazing that they can perform such a dramatic surgery through so small an incision. The surgeons rely on microscopes for parts of the procedure. There were no external stitches or staples in an effort to minimize the scar. It is in a rather conspicuous place. But like with similar incisions from other surgeries, I suspect that the scar will diminish over time.

Physical activities remain restricted. You are instructed not to lift anything over 5-10 pounds. This is the hardest restriction to follow as I find myself wanting to engage in regular activities around the house. I have to constantly catch myself and ask for help. Walking is highly recommended from the beginning and I’ve been doing about 1 mile each day. Since no longer taking narcotic pain meds, and getting some movement back in the neck, I did drive a short distance to the grocery store this week. Long drives are probably out for some time until more muscle strength is regained.

Rheumatoid arthritis symptoms flared after the surgery with increased joint pain and stiffness. Fatigue also increased but that could be from the recovery process. Flaring is to be expected given the stress put on my body from the anesthesia and surgery. Taking NSAIDs or steroids to help is not possible as they negatively impact the bone fusion process.

A follow-up appointment with the surgeon is in three weeks at which time they will take an x-ray to make sure the hardware remains in place and to check on the status of the bone fusion. It will be interesting to see the titanium hardware! The vertebrae can take 3-12 months to fully fuse.

At this early point, I am glad that I had the surgery. But time will tell if symptoms will continue to improve.

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In the five some years since being diagnosed with RA, I’ve tried a boatload of treatment options including various NSAIDS (chewed up my stomach), multiple DMARDs (one caused an allergic reaction and am currently injecting methotrexate), and I’m currently on my 7th biological medication – Rituxan infusions.

My rheumatologist always says that the treatment goal is that I hardly pay attention to my joints throughout the day. This sounds like everyday language for the ultimate target for RA treatment which is called clinical remission. This is defined as one or less than on tender joint, one or less than one swollen joint, low inflammation blood tests, and a strong patient self-assessment. Over the five years of treatment, I’ve never gotten anywhere close to these goals. But over the past couple of weeks it’s become clear that Rituxan is working like no other treatment combination has! Pain, swelling, and tenderness are hardly noticeable. My hip doesn’t hurt when sleeping or walking. My knee can pull me up steps. I can get out of bed relatively quickly without much stiffness. My right ankle that’s had 2 surgeries lets me know it’s there but it doesn’t scream at me all day along. The bottom line is that RA is starting to take a back seat in daily life…just like my rheumatologist hoped for! This is the first time in five year to have this experience and for this I am very grateful. It was a long time coming and many starts and stops and trying dozens of drug combinations. Of course, I’ll temper the joy just a little and take each pain free day at a time as you never know what lurks around the bend.

It took a while for me to figure out what was going on with Rituxan. These complex biological processes take time – in fact it’s been 4 months since my first infusion and I was already giving up hope for Rituxan to work. But I was also quite distracted over the past month fighting a battle with chronic and almost daily migraines. We’re not sure what’s causing them although my neurologist believes that genetics, a fight with an autoimmune disease, and the medications used to treat RA may all be contributing. So while RA is finally getting under control after 5 years, we’re busy trying to find the best treatment for the migraines. In addition to the emergency triptans (like Imitrex) to take when a migraine comes on, I’ve been on three different long term preventative medications, and have been into the infusion clinic two times for a cocktail of meds in an effort to break a long migraine cycle – the latest was a 4 day killer over the weekend. I have an MRI/MRA  (image of brain and blood vessels) scheduled next week to rule out any functional issues and we’re seeking insurance approval for botox injections which my doctor said works very well for his patients.

Two steps forward for RA treatment success after five long years and dozens of drugs! For this I will truly thank God as I was getting close to giving up hope as the options were getting few and far between. One step back with the nasty migraines. Such seems to be the life of a patient with a chronic disease. But just like what happened with RA, I believe that the migraines will eventually get under control. Two steps forward and one step back still equals forward progress.

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medrolRA created a desperate situation. Joint pain, stiffness, and swelling are at high levels. You know it’s bad when one can notice swelling in a skinny knee (just ask my wife about my bird legs). My rheumatologist commented the other day, “your hands feel hot today” intimating that inflammation was busy at work. Energy levels are such that simple daily tasks like cooking dinner are difficult. Cognitive functioning is so impaired that tackling issues at work and home are close to impossible (missed work…that’s another issue for another day). Systemic inflammation seems to running rampant – a recent C-reactive protein test was near an all- time high for me at 1.6 mg/dl and it’s been this high for the past four months. Tweaks to long term treatments are yet to show an impact.

It’s hard to believe but I actually asked my rheumatologist for steroids in an effort to knocks things down a notch. If you’ve read this blog over the past few years, you know that I’m not a big fan of corticosteroids (see earlier posts on Prednisone Side Effects, Love/Hate relationship,  and  my first post on the subject where I compared them to Nuclear Weapons). A stash of prednisone pills sits in my bin of prescriptions but it is avoided like the plague as the side effects often feel worse than the RA. My rheumy recommended something different and I agreed to try a Medrol Dose Pack which contains a batch of 4mg methylprednisolone pills titrated down over a period of days (see photo). I only had one experience with this approach back in 2008 when first diagnosed. These dose packs are used to treat a variety of inflammatory conditions (see package insert).

The first day brought a welcome burst of energy, much lower joint pain, an ability to focus, and the recurring headaches disappeared. It felt wonderful. Then it came time to sleep and it was clear that wasn’t going to be easy as my body and mind were both hyped up. An Ambien (zolpidem) sleeping pill was used to help which it did. Day two didn’t bring the same levels of energy and joint relief and I collapsed in a puddle left wondering if it was worth it. The next few days will serve as an experiment to see if rampant inflammation from the RA can be wrestled into submission by this powerful drug. If not, I’ll just have to wait to see if long term treatments will start working. After being through so many treatments over the past few years, my rheumy actually used the term “refractory RA” with me the other day which doesn’t engender much hope. In the meantime, I’ll seek any relief from any front including the corticosteroids I love to hate.

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PrednisoneIt seems that many RA patients have this love-hate relationship with prednisone. For me, it’s all hate. Every time RA symptoms seem out of control, my rheumatologist mentions taking some prednisone at least short term to knock down the symptoms. I understand the rationale. If a powerful anti-inflammatory like prednisone can be used, the disease modifying and biological drugs have an easier and quicker time impacting the disease. And the suggestion is given out of compassion in an effort to make me feel better. For that I’m appreciative. But my response tends to be, “I’d rather live with the symptoms of RA than with the side effects of prednisone”.

For me, even taking 1 mg of of prednisone brings about side effects with which are difficult to deal. I get so wired that sleep is impossible. A couple days of that and nobody wants to be around me. I get this constant jacked-up feeling making it difficult to relax. This makes me want to run around and keep busy with projects contributing to joint pain and fatigue. There’s a vicious cycle of mood swings that my family can easily see. I also get a voracious appetite causing me to eat anything that is not nailed down.

I also refuse to start long term treatment with prednisone. I’ve seen what it’s done to a colleague at work in terms of weight gain (also hard on the joints). The other long term side effects sound pretty nasty and include high blood sugar, increased risk of infections, thinning bones, impact on adrenal gland hormone production, and slower wound healing (see the Mayo Clinic’s site). There is a risk of glaucoma in the eyes and with my mother’s difficult case of glaucoma, that is something I should probably avoid. I remember 9 years ago when I had my first autoimmune symptom, uveitis in both eyes, the ophthalmologist prescribed a strong dosing regimen of prednisone drops. It was every two hours and I was to get up in the middle of the night and put in drops. He was adamant about doing this in order to save my eyes from long term damage. But he also cautioned me that I couldn’t take it for more than a month since steroid induced glaucoma was a real danger. Adding to these long term side effects is the fact that it’s difficult to wean off of corticosteroids (check out RA Guy’s recent post).

Yes, I keep a bottle of prednisone pills in the cabinet. But I try to avoid using them like the plague.

Photo credit: By D4duong (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons

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20121205-061120.jpgI received an official rheumatoid arthritis diagnosis almost four years ago. In that period of time I went through multiple treatment schemes (see the My Meds page) including four biologicals (Enbrel, Cimzia, Humira, and Orencia) and three DMARD chemicals (sulphsalazine, methotrexate, and Arava) in addition to numerous NSAIDS and the obligatory prednisone. As mentioned in blog posts over the past couple of months, it became increasingly apparent that the combination of Orencia and Arava was just not working. Sticking my head in the sand and ignoring the signs could only last so long while my wife and doctor tried to convince me that it was time to try something else. The evidence was becoming overwhelming…unrelenting fatigue beyond comprehension, increase in the number and intensity of swollen and tender joints, new joints including one shoulder and both hips presenting with signs of attack by RA, missed work, and a level of brain fog never experienced before. In addition, it felt like the monthly Orencia infusions might just as well have been plain saline solution as there was no improvement afterwards. On top of that, Arava was wrecking havoc on my digestive system and the bathroom and I became quite friendly.

While driving into the doctor’s office today, the inevitable started sinking in and I got nervous wondering what would happen. Most of this anxiety is probably grounded in the fact that I’ve been through a slew of treatments and I was feeling like options were beginning to run out. After an exam and conversation about symptoms, my rheumatologist emphatically stated that it’s time to change treatment. She continually expresses hope that we can find a medicine combination that will work for me. She got out a piece of paper and made two lists. The one on the left was for DMARDS that I haven’t tried yet and she wrote down Imuran and Cellcept. On the right she listed biologicals that I haven’t tried and she listed Remicade, Rituxin, and Actemra. In the middle she listed the newly approved oral biological Xeljanz which she dismissed as a possibility for now stating that she wanted to see more long-term data on efficacy and safety before widely using it. She recommended Imuran since it’s been around longer and has better efficacy data for treating RA. Imuran is an immunosuppressant commonly used to help organ transplant patients avoid tissue rejection. It is also used to treat many autoimmune diseases including RA, lupus, and MS. Since three TNF blockers didn’t seem to work well for me, she argued against Remicade but said that we’d keep that option on the list just in case we want to try it later. She said that Rituxan helps some of her RA patients but not as many as she would like. Actemra is the newest antibody biological for RA approved in the United States and she said that she’s seen it help some of her patients. It’s different from the TNF blockers and Orencia in that it targets interleukin 6 which is part of the autoimmune processes linked to RA. So we landed on the Imuran/Actemra combination and await insurance approval to begin the infusions. A trip to the lab for blood tests to establish baselines were ordered. In the meantime, doses of prednisone are prescribed to knock down inflammation.

Changing treatments brings about many questions but also hope that maybe it will provide some relief. Because relief would be a good thing right now!

Creative Commons photo credit: http://www.flickr.com/photos/busy-pochi/5170100206/

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