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Rheumatoid arthritis can be devastating and unpredictable. It attacks joints and can leave people twisted, crippled and in pain.
Ever since the 1950s doctors have been looking for drugs to ease pain and undo damage. When cortisone-type drugs were first introduced, they were perceived as wonder drugs. Patients felt immense improvement after starting a course of therapy with prednisolone, prednisone or dexamethasone. It wasn't until years later that consequences such as weight gain, cataracts, glaucoma, hypertension, muscle wasting, ulcers or diabetes were detected. It became clear that these "miracle" drugs came at a high price. One other long-term outcome of high-dose prolonged therapy with corticosteroids is osteoporosis. As one noted rheumatologist put it, these drugs "melt bone."
When so-called non-steroidal anti-inflammatory drugs were introduced, they were enthusiastically received. The belief was since they were "non-steroidal" they would not have serious side effects (like cortisone). Drugs like diclofenac (Voltaren), etodolac (Lodine), flurbiprofen (Ansaid), ibuprofen (Motrin), indomethacin (Indocin), ketoprofen (Orudis), nabumetone (Relafen), naproxen (Naprosyn), piroxicam (Feldene) and sulindac (Clinoril) helped ease pain, but not surprisingly they came with their own set of drawbacks. Stomach ulcers, hypertension, kidney problems, irregular heart rhythms and perhaps even heart attacks and strokes may result.
When the new "biologic" medications were introduced in the late 1990s, investigators hoped that these TNF blockers would fundamentally alter the course of rheumatoid arthritis. The new "miracle" drugs included adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi) and infliximab (Remicade). Because they calm an overactive immune system they were expected to dampen inflammation and even reverse the disease process.
Why are we not surprised that it took years to learn that there were unexpected complications? The FDA has warned that these drugs can increase the risk of certain cancers (lymphoma and leukemia). People who never had psoriasis may develop this skin problem when they stop the medicine. Because these drugs suppress the immune system, both bacterial and fungal infections may become life threatening. Liver damage is another rare but very serious reaction.
Now the FDA has approved another brand new medicine for rheumatoid arthritis. Like so many of its predecessors it is being heralded as a potential "blockbuster" against a very serious disease. But patients should be aware that Actemra (tocilizumab) may also have a dark side. In Japan, where it has already been on the market for years, this immune system modulator has been linked to serious infections and deaths. The drug can cause life-threatening allergic reactions (anaphylaxis), gastrointestinal perforations, headache, hypertension, elevated liver enzymes or cholesterol. Like other immune-suppressing drugs, there is concern that Actemra may increase the risk of cancer.
Rheumatoid arthritis patients may be glad to have another option, since the current treatments leave much to be desired. Patients should be aware, however, that most arthritis drugs are double-edged swords and can do a lot of damage as well as good.
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So what is the alternative...can you crepe hangers tell us? Sit in a wheel chair and become horribly crippled?
I suffered an ulcer in 1996 after taking Naperson for sore knees; and was fortunate not to lose part of my stomach, I later learned.
A rheumatologist I saw later prescribed Osteo-Bi-Flex and it has helped so much.
The ulcer incident has taught me to be very careful about the drugs I take.
Elaine
EB,
No cliff hanger, nothing new either. Drugs are bad; each has it's set of positive effects and negative effects. It's the job of your doctor and pharmacist to make you aware and consider the risks and benefits of the medications used to treat disease. The more harmful the disease the more willing we are to tolerate side-effects.
When medications are taken properly we can maximize benefits and limit side-effects.
Sorry, there are no miracle drugs or cures.
So with YOUR doctor/pharmacist/nurse/health care provider learn about YOUR disease and YOUR medication and then you can take control of YOUR life.
I became aware of the potential problems of NSAIDs when my prescribed Motrin (for osteoarthritis) caused stomach ulcers and internal bleeding that caused me to pass out while driving on the Hollywood Freeway!
I was diagnosed with ra 4 yrs. ago. I was put on bunch of drugs, among them ibuprofen and prednisone, because of this I now have stage 3 kidney disease and cataracts.
I was not told about the possible side effects then, now whenever I'm prescribed a new drug I try to find as much info as possible before I take anything that could hurt me and effect me for the rest of my life.
I am trying to get someone to look into the substandard generic Ibuprofen 800 supplied by Amneal. Most of the pharmacies in Phoenix are switching their supplier from Watson to Amneal with disastrous consequences. Doctors are switching patients to more expensive drugs. I base this information on the following:
I am a 61 year old woman who has osteoarthritis and have obtained regular relief from Ibuprofen 800. In December, I got a new prescription where the Ibuprofen was from Amneal. I did not have relief and suffered severely. When I did not heal, I contacted Walgreens and learned about the switch from Watson Pharmaceuticals to Amneal.
To make sure that it was not just a new problem with my body, I got some Ibuprofen 800 from a friend whose supply was from Watson, within three days I was back to feeling better again. I discussed it with a friend who was suffering and because of that her Doctor gave her a new more expensive Arthritis drug. I asked her to check her supply and it was from Amneal. If she had still been receiving effective Ibuprofen 800, her Doctor would not have had to change her prescription. Either Almneal's quality control has slipped or its manufacturing standards do not match the requirements for a generic.
Many of us are suffering. Please investigate. I tried to switch from Walgreens, but CVS and the SuperMarkets have all switched to Amneal. Wal-Mart is using Dr. Reddy and I will try them in the meantime. Please help us.
What are the side effects of Tramadol?
PEOPLE'S PHARMACY RESPONSE: DIZZINESS, NAUSEA, CONSTIPATION, HEADACHE, DROWSINESS, VOMITING, ITCHING, AGITATION, WEAKNESS, SWEATING, INDIGESTION, DRY MOUTH, DIARRHEA
(EVIDENTLY SOME PEOPLE EXPERIENCE CONSTIPATION, BUT OTHERS GET DIARRHEA).
THIS LIST IS NOT COMPLETE. YOU CAN FIND A FULLER LIST AT DAILYMED.
ALD,
Tramadol works like narcotics and antidepressants. It may cause headache, constipation, dizziness, sedation, serotonin syndrome (agitation, muscle twitching, fast/hard heart beat, nausea, vomiting). Stopping abruptly may cause withdrawal. Taking too much will decrease breathing.
These side-effects are similar to other pain medications and antidepressants.
If you are taking Tramadol and other antidepressants your risk of serotonin syndrome is greater.
Thankk you for the information. I need to search more on serotonin syndrome.
I have been taking Methotrexate for about a year and started taking Simponi 8 months ago for rheumatoid arthritis. Of course I do not know what long term effects, if any, I will suffer in the future, but I will tell you this. 14 months ago I could not tie my shoes, button a shirt, or cut my own food. Today I can do all those things and have very little pain. I still have some trouble with a tight jar lid now and then, but I did before I had arthritis. I can assure you, I would not be alive today without these medicines.
What is serotonin syndrome?
ALD,
Serotonin syndrome is very rare. But it can be caused usually by a combination of medications that act on serotonin receptors. Medications include: antidepressants, St. John's Wort, LSD, tramadol, Zofran, Zyvox, Duragesic, Demerol and others that either increase serotonin or decrease it's removal.
When the serotonin receptor is exposed to enough serotonin then serotonin syndrome may arise. Serotonin Syndrome includes: high blood pressure, tremor (shaking), high temperature, uncontrolled movements, diarrhea.
Be cautious that using several medications that act on serotonin increase your risk of this rare, but potentially fatal drug reaction.
I requested info on cortisone shots for pain. I have been getting them for 2 years at least. I would like to find info on the side effects of cortisone somewhere. Could someone respond with their experiences. I am 83 so I guess I've was lucky to be healthy until my 80's.
CLC,
To start with, you are in your 80's and you have a positive outlook on life. As Abe Lincoln said, "Most people are just about as happy as they make up their minds to be."
If you have been using cortisone shots for 2 years without many side-effects, I'd say you probably don't have many. Knowledge in the wrong hands can be dangerous the following is a link that list many possible side-effects few if any of these are probable side-effects.
Count your blessings ask your doctor if their are safer alternatives, but if it isn't broke don't fix it.
I recently was prescribed Prednisone for a disease Polymylagia Rheumatica. This is the 1st time in my life (age 66) I have taken medication. One of the side effects has been indigestion, waking at night and experiencing it. What is the specific cause of the indigestion, and what "natural" food etc. can be used to deal with (not merely cover the symptom) the root cause.
My 30 something son has ankylosing spondylitis ( has severe hip pain etc. and all the other things that come with an autoimmune disease). He has had unacceptable side effects with every NSAID he was given - severe GI issues. He has been receiving injections in his SI joint which usually helps for a limited time - these can only be given three times a year - and have their own side effects but it does help.
His rheumatologist has prescribed Embrel but he has so many concerns from researching these drugs, he does not want to take it. My husband and I can understand his concerns.
What hope is there for him and his fellow sufferers? He has had a thorough evaluation by a world renowned immunologist at a major medical school and found out he has unusually aggressive T-cells. I am not sure I understand what that means for him. Can you help me understand that?
If this were your son, what advice would you offer him (remembering that he is an adult and has to make his own decisions)?
Thank you!
MKM
MKM,
Please confirm with the immunologist. He has an autoimmune disease which means is own white blood cells (T-cells) that usually fight infection are killing good healthy cells.
This sounds like it means for him, he will need to greatly suppress his immune system to stop his T-cell from attacking healthy cells.
My advice would be to weigh the risks versus benefits of the medications Embrel and others that will suppress his immune system.
In the Wall Street Journal 11/2/2010, page D3: "Though corticosteroids provide short-term relief from tendon pain, they increase pain in the long term, according to a meta-analysis in the Lancet. ...[S]tudies...found...benefits were short-lived. ...[C]orticosteroids were associated with pain relief for up to eight weeks, but with greater pain at six months and one year. It's unclear why....but the researchers suggested that the injection could weaken tendons' internal structure."
As you probably already know, cortisone has many nasty side effects, like osteoporosis and a weakened immune system.
What is wrong with the reasonable, carefully monitored use of opiates/narcotics to treat pain? And with fiber to help the intestines! A lot of medical books say this is the way to go. These newer drugs blow your liver, kidneys, stomach, immune system, etc. Is it media hysteria about drug addiction?
The research shows that most people who are in pain treat these drugs with respect because they want them to work, (e.g. the study showing that pain patients who could control their own morphine pumps used a lot less than those who had to depend on begging shots from a busy nurse). A friend who works in a nursing home told me that some nurses have private opinions about narcotics, and even when a patient has orders for regular narcotics, these nurses find excuses to avoid giving them! So cruel. As pain management doctors say "Don't let the pain get ahead of you because then it's harder to control and needs more medication."
Good afternoon,
I have been diagnosed with RA.. I am 62, active. have had issues with bad knees, but nothing which had prevented me from biking, walking, dancing. This has hit me for a loop. I have never been on medication... so the NSAID's are totally new. Oh, also have gouty arthritis, left foot. needless to day, I was on some NSAID's for one week and gave them up.
The side effects were dizziness, heart palpitations, knotted stomach, also was on a 6 day regiment of predsidone... I am over all of that... have some pain, but nothing I cannot get over... what I am now investigating is the natural remedy... think it is the only way to go at this point. The thought of not walking, biking, dancing, working out is not making me happy. miserable in fact... I feel like i have gained 15 lbs in a week (no, I have not), I am always tired... (and IO stopped taking the pills on Monday March 21st... today is Thursday March 24th... and stomach is still in knots... if this is what the NSAID's do then I have no need for them.
This site is great for all kinds of information, and I am going thru all the messages, recipes., etc. to find some sort of relief... getting up in the morning is the worst. This had never happened to me. oh, sure, some stiffness... but since my knee operation in 1973, I have been fine. NOW... I want to scream... I want to sleep... I will try all the remedies and hope and pray it works out fine... thanks for letting me vent... God bless all.
Jenny
My husband has been prescribed Prednisolone after an acute first attach of rheumatoid arthritis ( he also has Myelodysplasia). Last week he suffered a sudden, traumatizing episode diagnosed as Transitional Global Amnesia, where he had a total short-term memory loss. Has anyone experienced TGA and could it be a side effect of Prednisolone - the hospital to which he was admitted was unsure.
vivian...I can relate. 51 with RA. If I ever was sick with anything before, whatever they gave worked.
Then this RA comes along. Nothing seems to work. But the Remicade infusions are helping with the tiredness feeling. I find it easier to deal with the pain... which is BAD, especially in a.m or after sitting for more than 20 mins.... but it is worse when I have the tiredness on top of it. It is a scary disease (all diseases are).. but this one has me scared.
I am 36 now diagnosed two years ago with severe AS and have been hospitalized many times since. I have been on most NSAD's over the past 10 years without knowledge of current condition. Once diagnosed I have been on MTX, SSZ, Folic acid,T-3, liver function is way to high to continue these drugs.
Withdrew from all but SSZ and now inject Humira for the past 4-5 months every two weeks, and I was very scared of side effects however I'm back to work, stay awake for longer than three hours, pain has reduced somewhat, tie my own shoes, walk without assistance, not scared to climb stairs, the list goes on. I am not praising this drug but the option to live again at a young age with kids is priceless.
Respectively, I want to point out that Osteo BiFlex does nothing at all for RA. It possibly can help some people with osteoarthritis. I used it myself for many years, after being diagnosed with OA. (btw, a pharmacist I had at the time who is more open minded about alternative treatments, pointed out that one must take a high enough dose of glucosamine/chondroitan, for it too maybe help) I thought it was helping my knee pain but after years of spending lots of money, I stopped it and had no difference off it than on it.