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Medications for Rheumatoid arthritis - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Very Good Posted in: Bones, Muscles and Joints
Answered by

General & Family Physician
Practicing since : 2009
Answered : 636 Questions
Doctor :   Hi
Doctor :  
How can I help you?
User :   I was wanting to talk about different medications used for the treatment for arthritis rheumatiod
Doctor :  
Sure
Doctor :  
Proceed with it
User :   Okay so I have been on methotrexate 20mg by injection once weekly
User :   with folic acid
User :   I understand that is a DMAR
User :   but I had nothing for the pain so I was put on oxycotin, as tylenol and ibuprofen did not work
Doctor :   Ok

User :   now I was having a whole bunch of side effects and was not allowed to work when taking a narcotic
User :   so I I tried to tell my rheumatologist that I did not think methotrexate was the best drug for me
User :   she wanted to put me on prednisone and plaquenil
Doctor :   Ok

User :   for some odd reason I am too scared to take prednisone, so I said no
Doctor :   Ok

User :   she got upset ans so did I and now she has referred me to a different rheumatologist
User :   she gave me a prescription for plaquenil
User :   but thats it
Doctor :   ok

User :   and I know thats a DMAR as well
User :   so now I have gone off the methotrexate
User :   as I dont know what to really do
Doctor :  
Ok
Doctor :  
Since when are you on treatment for RA?
User :   started 3 months ago
User :   but I had this disease as a child
Doctor :  
Also I would like to know about your age and gender
Doctor :  
Ok
User :   it was in a 5 year remission
User :   I am 22/ female
Doctor :  
Fine
User :   as a child I tried naproxin, did not work
User :   may be spelt wrong
Doctor :  
4 months back, were there any symptoms?
User :   yes swelling that came and went
Doctor :  
ok
User :   mainly in m right hand and right ankel
User :   with pain
Doctor :  
and later, why did you start treatmen
Doctor :  
did the pain become worse?
User :   yes, pain increased, and more joints became involved
Doctor :   ok

User :   so I went on to the methotrexate
Doctor :  
So yes a DMARD is required
User :   as a child the side effects from methotrexate where not as bad, but this time they were too much
User :   so any ways
Doctor :   Ok
Doctor :  
fine, there are other drugs
User :   Now I am going off the methotrexate and oxycotin, to go on this new plaquenil
Doctor :  
and you can switch
User :   but now I dont have any anti inflamatory because I said no to the prednisone
Doctor :  
along with that, you shall require antiinflammatory
Doctor :  
and a steroid is required for long term prevention
Doctor :  
so, why did you say no to Prednisone?
User :   because it as well has horrible side effects I did not feel a steriod was necessary
User :   I just wanted a NSAID
Doctor :   NSAIDs are better for acute management

User :   but my rheumatologist did not listen to me, I feel I know my body best, I grew up with the disease
Doctor :  
steroids for prevention rather
Doctor :  
have you taken Prednisone before?
User :   but acute managment is what I need because to me the DMARDs are the long term managment
User :   no but I have had family members taken it
Doctor :   Ok

Doctor :  
You should try Prednisone
Doctor :  
there is no harm in it
Doctor :  
it is a good option
Doctor :  
the dosage should be tailor made
Doctor :  
that is the key
User :   what is wrong with a DMARD and a NSAID
Doctor :   DMARD is essential

Doctor :  
that should be taken
Doctor :  
NSAID are not good for repeated use
Doctor :  
as they have more of adverse effects
User :   hmm
Doctor :  
Even steroids shall be withdrawn after some time
Doctor :  
need not be taken for long
User :   because I went to a walk in doctor and he gave me a sample of Arthrotec 50* and I am scared to take them because of the birthcontrol failure risk with the misoprostol in it
User :   so I was going to ask for just the diclofenac with no other drug
Doctor :   Ok

User :   i know it is hard on the stomach
Doctor :  
Yes, diclofenac is good for relieving pain
Doctor :  
and also on kidneys
User :   i feel like I am being so picky but I just dont feel the arthritis is that bad , I just need somethign to get the pain under control untill the DMAR can work and hopefully the RA will go back into remission
Doctor :   Ok

Doctor :  
But my advice would be to consider steroids
Doctor :  
it is a good choice
User :   I was told I could take the plaquenil with the methotrexate at half dose but I dont see how taking 2 DMARDs helps
Doctor :  
do not say no to it without trying
User :   i would take seriods if there was a different kind
Doctor :  
Dmards are meant to prevent the progression of disease
Doctor :  
so if one drug is not working fine, then a combination is preferred as usual
User :   so it is better to take the methotrexate at a lower dose with the plaquenil
User :   then just the plaquenil its self
Doctor :   Combination is not a bad idea

Doctor :  
Do discuss about it with your Rheumatologist
User :   I wish I could she has said she no longer wants to treat me
User :   so I am back on the waiting list for another one
User :   just trying to figure out what to do in the mean time
Doctor :   Ok

User :   last topic focusing on Arthrotec
Doctor :  
But as you know, I cannot advise non OTCs over chat
User :   I know
Doctor :   You wanted to ask about Arthrotec

User :   over the counter?
Doctor :   Yes

User :   well I was wonderign what was better for a young female the diclofenac alone or with the misoprostol coating
Doctor :   Misoprostol is given to protect your stomach

Doctor :   as it shall produce a protective covering over the stomach

Doctor :  
and reduce the gastric side effects
User :   but its complications are linked to birthcontrol failure, infertility later on
User :   specifically the misoprostol
User :   not the diclofenac
User :   so you as a doctor would feel confortable giving a young female patient that drug?
Doctor :   The dosage shall be rightly given

Doctor :  
there should not be a problem
Doctor :  
it is contraindicated only in pregnany women
Doctor :  
otherwise no contraindications
User :   hmm so there is no reason to get just the diclofenac alone
Doctor :   Yes, you can take Misoprostol

Doctor :  
it is not of concern for you now
User :   hmmm
User :   thanks
User :   any other helpful advice for drugs for RA?
Doctor :   Continue with Dmards and symptomatic treatment

Doctor :  
there are certain other drugs which you can discuss with your doctor
Doctor :  
to reduce the swelling
User :   thats the thing swelling is not usually the problem the pain is
User :   I was told my arthritis is reactive
User :   so its pendulum
User :   comes and goes
Doctor :  
Ok
User :   its weird
Doctor :   Both swelling and pain are a part of inflammation
User :   its scarey because I was misdiagnosed as a child so many times before that I wonder if I am again
Doctor :  
I hope you agree with it
User :   yeah I just wish I would see the swelling more often when the pain is occuring
User :   so i didn't think I was going crazy hahah
Doctor :   Ok

Doctor :   the other drugs that could help you include etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira)
Doctor :   which you can discuss with your doctor during your consultation

User :   yeah, I hope to, just wish that was sooner rather then later
User :   as I said my rheumatologist didn't like that I was so picky
User :   so now she has passed me off to another rheumatologist
User :   I felt neglected
Doctor :   Yes, but in your next consultation you can do it

Doctor :  
no need to feel like that
Doctor :  
it is for your better as well
Doctor :  
you have been referred
User :   yeah
Doctor :  
because such disease management requires a good rapport b/w the doctor and the patient
Doctor :   So do not have negative thoughts on that

Doctor :  
you shall get better help
User :   thanks
User :   Where are you from if you dont mind me asking
Doctor :   I am from India

User :   Okay neat
User :   YOu should have councilers on this website as well
Doctor :   Sure, we shall do it in future

Doctor :  
Is there any thing else I can help you with?
User :   I just feel like I am bothersome
User :   I could ask millions of questions haha
Doctor :   Ok
Doctor :  
You can avail our service anytime
User :   yeah I have unlimited for today
User :   but I could see how it could get tiredsome talking to the same person
Doctor :   From my side?

User :   yeah is it?
Doctor :   No

Doctor :   We are here to help you
Doctor :  
so do not have inhibitions
User :   I wish more doctors had that attitude, your very nice and understanding, I appriciate that
Doctor :   Thank you
User :   Okay are you okay talking about a second problem
Doctor :   Sure

Doctor :  
Proceed with it
User :   Back problem
Doctor :  
Ok
User :   When I talk to people they just assume it is linked to the RA but I am not sure it is
User :   I had an X-Ray
Doctor :   Ok

User :   Stated I had Hyperostitis (may be spelt wrong) and Mild Osteoarthritis and Mild disk degeneration of the lower lumbar region
User :   I was shocked when I am only 22 years old
User :   harldy wear high heels
User :   though I did grow up with JRA
Doctor :  
Ok
Doctor :  
Now the immune system does have a role on these ailments
User :   I am shocked how it has suddenly given me so much trouble in the past 5 to 6 weks
User :   To me it causes more pain then any other troubles I have had
Doctor :  
and because of that osteoarthritic and other degenerative changes would be seen
User :   sharp to dull pain in the lower back
Doctor :   Ok

User :   I am doing massage therapy for it
Doctor :   That is a good option

User :   I am also doing physiotherapy for it (but he seems to link it to the RA) dont know why
User :   but is there any thing else I could do
User :   as you know I am already switching and on so many different drugs
Doctor :   The medications that you take for RA shall help you

Doctor :  
so there is no need of separate medications for back pain
Doctor :   supportive therapies are good enough
Doctor :  
and you should benefit out of it
User :   supportive therapies? so the massage and physio
Doctor :   Right

Doctor :  
If Chiro is beneficial
Doctor :  
then that as well
User :   but if you have osteo, how would that help?
Doctor :  
for the pain mainly
Doctor :  
the other inflammatory process shall react to your Dmard
Doctor :  
and also antiinflammatories
User :   True
Doctor :  
Diclo is a good drug for it
User :   What is Diclo?
User :   oh diclofenac
Doctor :  
Sorry, Diclofenac
User :   I am just so hesitant about the misoprostol
Doctor :  
It is given as a protection
Doctor :  
and you are afraid of that
Doctor :  
Misoprostol has no role in inflammation
User :   yeah it seems to have more complications with it when it has the protectant
Doctor :  
So if you are not having gastric issues, then go ahead with just Diclofenac
User :   yeah just hard, when it seems I am in the doctors office every second day, sometimes I feel not knowing is better
Doctor :   Yes, in a way it is

Doctor :  
if you google health related info
Doctor :  
you are more confused
Doctor :  
and indecisive
Doctor :  
So it is not a recommended practice from my side
User :   Its hard cause I dont do google I just read the monographs at the website, so example pfizer
Doctor :   Ok

Doctor :  
Anything web related I mean
User :   still not good
User :   yeah
User :   but its just as bad looking in books
Doctor :   Ok

User :   I have a drug guide book says the same as the web
Doctor :  
Just try to reduce that research
Doctor :  
and you will be calmer
User :   it makes me scared to be sexually active if I take the misoprostol
User :   and I am on BC
Doctor :   Ok, there is no problem

Doctor :  
Misoprostol is a stimulant, thats it
Doctor :  
does not have effects on the molecular level
User :   okay lol
Doctor :  
for future pregnancy related issues
User :   that helps
Doctor :   Is there any thing else I can help you with?

User :   No not right now
User :   thanks
Doctor :   Thanks for consulting HealthcareMagic. Bye for now. Please refer your friends to our service.
User :   You were helpful
Doctor :   Thanks again
User :   okay bye
User :   Hello?
Doctor :   Hi
User :   Are you the smae doctor or different?
User :   same*
Doctor :   The same

Doctor :  
You are still in the same chat
User :   Oh hmmm, it didn't let me end it
Doctor :   Ok

Doctor :  
fine
Doctor :  
Bye for now
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