Rheumatoid Arthritis Treatments – NSAIDs

Rheumatoid Arthritis Treatments

Oral Meds

 

 

There are many different treatments for RA. Some of the more common ones include NSAIDs (non-steroidal anti-inflammatory drugs), DMARDs (disease modifying anti-rheumatic drugs), steroids,  and biologics. Today, I’m focusing on NSAIDs

Anti-inflammatory drugs include (generic names used):

  • Ibuprofen
  • Naproxen Sodium
  • Aspirin
  • Celecoxib
  • Sulindac
  • Oxaprozin
  • Salsalate
  • Diflunisal
  • Piroxicam
  • Indomethacin
  • Etodolac
  • Meloxicam
  • Naproxen
  • Nabumetone
  • Diclofenac

NSAIDs work to decrease inflammation. They can work quite well in RA and other inflammatory diseases, however, they should be used in the lowest dose possible to help decrease the risk of side effects.

Side effects of NSAIDs can include:

  • Ulcers
  • Gastrointestinal bleeding
  • Increased bleeding tendency
  • Liver and/or kidney problems
  • High blood pressure
  • Edema

If you are taking NSAIDs for RA, your doctor will want to periodically assess your liver and kidney function. This is done through blood tests and if your liver enzymes or kidney function is not within range, your physician may ask you to stop the medications.

You should report ulcers or gastrointestinal bleeding to your physician right away. Symptoms of ulcer may include stomach pain and nausea. Gastrointestinal bleeding may present with coffee ground emesis, black or tarry stools, pale skin, severe fatigue.

Please consult your physician for any concerns or before initiating NSAID therapy.


http://www.webmd.com/osteoarthritis/guide/anti-inflammatory-drugs

Harrison’s Rheumatology: Editor Anthony S. Fauci

 

Rheumatoid Arthritis Complications

rt hand 5

Rheumatoid Arthritis Complications

 

Rheumatoid Arthritis is an autoimmune disease that can cause widespread complications.

Muscles and Joints: 

Joint deterioration and deformities making it difficult to perform daily tasks, like buttoning a shirt, pulling up a zipper, tying shoes, or even just pulling on clothing.

Carpal tunnel syndrome

Inflammation may cause tendon rupture. This most commonly affects the tendons on the back of the hands.

Cervical myelopathy – a dislocation of the cervical spine which can put pressure on the spinal cord.

Muscles may become weak and patients may have severe muscle spasms. In the photo below, the toes are spasming and pulling downward.

Spasming Toes

Nerves: Peripheral Neuropathy can result in numbness, tingling, and burning tingling in the hands and feet from nerve damage

Blood/Blood Vessels: Many patients with RA develop anemia, and some of the medications used to treat RA can affect other blood components, like the white blood cells. Anemia can lead to dizziness, weakness, and fatigue.  Decreased white count can make the RA patient more prone to infection.

Inflammation of the blood vessels, or vasculitis is a rare complication of RA. It causes thickening, of the blood vessel walls leading to problems with blood flow through the vessels.

Eyes: Scleritis and Episcleritis – inflammation of the blood vessels of the eye – can cause a gritty sensation and redness of the eyes. This can result in corneal damage.

Increased Risk of Infection: Just having RA makes the patient more prone to infection, but also the medications taken can put the person at a higher risk of developing an infection.

Skin: Rheumatoid nodules develop in about one fifth of RA patients. These nodules are usually under the skin and appear on the forearms, heels, fingers, and elbows. They may develop gradually or appear suddenly. These nodules may also occur in the lungs and heart.

Osteoporosis: Loss of bone density is more common in RA patients.

Lung Issues: Chronic lung diseases like interstitial fibrosis, pulmonary hypertension, pleural effusion, and nodules.

Rheumatoid Lung is a group of lung conditions commonly found in RA patients. It includes nodules, fibrosis, and pleural effusions.

These lung issues may present with symptoms of shortness of breath, chest pain, and cough.

Heart: RA patients have an increased risk for developing heart disease, heart attack, stroke, and blood clots. They also have a higher risk for developing pericarditis – inflammation of the sac surrounding the heart and myocarditis – inflammation of the heart muscle.

Cancer: RA patients have an increased risk of developing lymphoma, leukemia, and other cancers. Use of TNF blockers may possibly lead to an increased risk.

Emotional: Living day to day with a chronic, painful illness may lead to depression and anxiety, yet many RA sufferers don’t discuss this with their physicians.

While there are many complications of RA, getting an early diagnosis and following the treatment plan may help lower your risk of developing any of them.

If you have symptoms of any of the complications of this disease, please talk to your physician about it right away. Delaying may lead to worsening of the condition.

 References:

http://www.nhs.uk/Conditions/Rheumatoid-arthritis/Pages/Complications.aspx

http://umm.edu/health/medical/reports/articles/rheumatoid-arthritis

http://www.nytimes.com/health/guides/disease/rheumatoid-arthritis/complications.html

http://www.healthline.com/health/rheumatoid-arthritis-complications#1

http://www.webmd.com/rheumatoid-arthritis/guide/rheumatoid-arthritis-complications

 

New Feature

Boy in sidecar

 

New Feature

I’ve added a new feature here at GimpyGal. Downloadable forms you can complete and take to your physician’s office. So far, I only have one – Autoimmune Profile. It has check boxes to assess Pain, fatigue, swelling, fever, etc. and it has text boxes where you can document questions, etc.

This document is a weekly document to help you and your physician evaluate the effectiveness of your treatment regimen.

Just click on the “Documents” link to view and/or download the available documents.

As time goes on, I will add other documents. If you have a specific request, please feel free to contact me.

Depression and Suicidal Thoughts

_DSC0293-2 - Copy

 

Depression and Suicidal Thoughts

 

With the recent death of actor Robin Williams, I felt it was important to interrupt my series on Rheumatoid Arthritis to talk about depression.

Studies show between 15 and 60% of people dealing with chronic illness, experience clinical depression. However, I believe at different times in the course of the disease, most people who deal with chronic illness and autoimmune diseases face some degree of depression. The diseases attack the body and once we learn what our “new normal” is for life, something changes, and we must accept a revised version of normal. This can lead to depression.

Depression is not a sign of weakness. Depression is not a sign you don’t have enough faith in God. Depression is not something you just push through and deal with.

Depression is a very serious sign that something is wrong and you need help to deal with it. In our “pull yourself up by the bootstraps world” we have difficulty understanding this insidious thief. It robs our joy, and steals our happiness, yet many times we don’t understand why.

Dealing with chronic illness day in day out is wearisome. Fatigue, coupled with pain, and flu-like symptoms takes a toll on the body and mind. If you’re experiencing depression symptoms along with your disease symptoms, please do not ignore them.

Symptoms of Depression Include:
  • Feeling sad, empty
  • Difficulty concentrating or making decisions
  • Loss of interest
  • Increased fatigue
  • Feelings of guilt, worthlessness, helplessness
  • Feelings of hopelessness
  • Irritability
  • Restlessness
  • Fixating on past failures
  • Insomnia
  • Sleeping too much
  • Persistent anxiety
  • Overeating or loss of appetite
  • Frequent thoughts of death
  • Suicide attempts
Warning Signs of Suicide in Depressed Persons:
  • A sudden switch from being sad to suddenly calm or even happy
  • Frequently talking or thinking about death
  • Depression that worsenings
  • Putting affairs in order
  • Tempting fate by risky behavior
  • Losing interest in things the person once cared for
  • Saying things like “It would be better if I weren’t here” or wanting out
  • Making comments about feeling worthless, or hopeless
  • Visiting those the person cares about

Depression must be taken very seriously. The risk of suicide with depression is high and anyone who expresses suicidal thoughts should be taken seriously. Call 1-800-SUICIDE (1-800-784-2433) or 1-800-TALK (1-800-273-8255) or the Deaf hotline at 1-800-799-4TTY (1-800-799-4889).

 

References:

http://www.lupus.org/answers/entry/can-lupus-cause-depression

http://www.webmd.com/depression/guide/detecting-depression

http://www.mayoclinic.org/diseases-conditions/depression/basics/symptoms/con-20032977

 

 

Disabilities in Disney World

Disney World

There has been much discussion on the DisDining Blog on her Top 10 Bad Behaviors on a Disney World Vacation. Her number 6 urges park goers to watch out for strollers, wheelchairs, and scooters and not cut them off because none of these can stop quickly.

Many of the people have made some remarks about those who use scooter and/or wheelchairs. These comments show a lack of understanding about invisible diseases like Lupus, Rheumatoid Arthritis, Psoriatic Arthritis, Multiple Sclerosis, Heart Disease, severe Peripheral Neuropathy, and many, many more.

The comments ranged from frustrated to cruel. Here are a few examples:

there are privileges for people in wheel chairs at Disney also. One year we had to use it for our daughter when she had rods put in her back. BUT the number of rude people in wheel chairs and parents pushing strollers is huge. I could bet that 80% of the people who use them don’t really need them at all. Most are overweight and that is their excuse for using one.

One pet peeve of mine is scooters going to the front of the line. I am fine with it obviously if you are handicapped and you truly cant stand in line but a person who has a scooter because they are overweight or have a sore ankle and brings 5 or 6 people with them to the front of the line and then get off the scooter and walk onto the ride. Its fine to have a scooter to get around the park to cut down on the amount of time you are on your feet but if you can walk on your own then wait in line like everybody else.

#6 – this is a two way street! I won’t cut them off, but most of these people upset me every day on my trip because they are using wheelchairs when they don’t need to or they are constantly cutting me off!

The fat ppl who rent the motor scooters ans practically hit and run ur children. Also obesity is not a handicap and an excuse to cut the line. A bunch of excited four year olds should get first crack at pirates or the mansion over someone who ate too many fries to walk

I have to agree with most, however im not a 100% in agreement with #6 as I read on a lot of people also feel the same way. If I see a family walking with a stroller I will stop and stop my children so the rest of the family with the stroller can stay together that’s not a problem for me. My problem is the scooters and the wheel chairs . If some one is in a wheelchair or scooter for a medical reason fine its the over weight people and the lazy people that don’t feel like walking all day that drive me crazy . So stay back at the pool. I don’t mean to sound mean but some people use the wheelchairs and scooters to hold bags and to cart young tired children around or they are too heavy to walk . Now, aunt gertie lets little Bobby drive the scooter in circles while waiting for his family to come off space mountain and running everyone in sight over. And instead of saying oh im sorry they think its cute lil Bobby is driving a scooter. like I said before stay back at the hotel lil Bobby im sure will tell you all about his trip to magic kingdom in the morning.

The over-reaching think I see, is many of these people believe those who rent scooters and don’t look ill, are just fat and lazy.

I do realize some of the people making these comments do not want to understand chronic, invisible illness and nothing anyone says will make a difference, but there are some people who honestly don’t understand invisible illnesses and think if someone looks healthy, they are. After all, most of us with chronic illnesses strive to look our best when we go out in public. We actually put on make-up, dress decent, and try to appear normal.

In this post, I’m going to focus on autoimmune diseases in general. Future posts I will delve into the individual diseases and the symptoms caused be each one. Hopefully some of my friends who suffer from various diseases will allow me to share their photos.

Below, I’ve shared some of my photos. This is something I rarely do, but I thought it was important. I don’t look ill, in spite of having more than one autoimmune disease.

The first photo is before I developed the autoimmune diseases. Second is several years after a very bad flare necessitating prednisone for many years. The third photo is more current. I’ve been off prednisone except in short bursts for several years.

In the middle photo, it’s obvious that I’m quite heavy, and in the last photo, I’m still heavy. It’s something I’m working on, but it’s difficult when mobility is limited. The point of the photos is, while I look obese in the last ones, I don’t look ill.

Most people with autoimmune diseases look just fine. We don’t have missing limbs, limbs in casts (unless we’ve had recent surgery or a flare causing problems in a specific joint). In fact, to look us most people would never know we had a chronic illness.

I’ve shared these photos to show how chronic illness has changed me. Before I developed RA, I was very active: went to the gym three days a week, took Tae Kwon Do three nights a week, and played football, volleyball, went bowling, dancing, etc on the weekends – in addition to practicing Tae Kwon Do. I was young, energetic, and healthy.

Fast forward a few years. The middle picture shows what immobility and prednisone can do to the body. This photo was taken after I’d been on prednisone for many years. I didn’t like the changes in my body, but there was little I could do. 

Finally, my physician found the right combination of medications and I’m no longer on prednisone except in short bursts. I am still overweight. It’s a long road to return to a healthy weight.

My diseases have progressed to the point that I now must use a scooter to go any distance. I haven’t been able to go to Disney World or Disneyland for several years without the use of a scooter. If I’m going to a large store, I have to use one also.

People look at me like I’m “fat and lazy” and use the scooter because I don’t want to walk. This couldn’t be any farther from the truth. I would love to be that energetic girl who went non-stop once again, but unfortunately I cannot. For many years when we went to theme parks, I pushed myself and refused to use a wheelchair or scooter, but these diseases don’t stand still – even with medications the disease progresses. Not like it would without the medications, however. 

Most autoimmune diseases cause the following symptoms:

Fatigue – unlike normal fatigue, the deep, bone-aching, intense fatigue isn’t relieved by rest. Many times those with autoimmune diseases wake up feeling even more tired than when they went to bed. Many times we cannot do the things we really want to do. It’s frustrating for us, then when others get angry or upset with us over it, it multiplies the symptoms.

Muscle and Joint Pain – This can range from burning and aching to feeling like someone has a jackhammer destroying the joints – which in the case of Rheumatoid Arthritis and Psoriatic Arthritis – is kind of true since the body’s immune system is destroying the joint. The pain may also move. One day it may be the feet, the next the hand. It can also move hour to hour. Many times it’s a generalized achiness. 

Fever – at times people with autoimmune disorders will have an elevated temperature. With some AIs (autoimmune) it can be a low-grade, but in others, the fever may go quite high.

Hair loss – The hair loss can be caused by the disease or by the medications to treat the illness.

Flu-like symptoms – All AIs cause generalized malaise, or ill-feeling. Think about how you felt the last time you had the flu. People with an autoimmune disease feel like this most of the time. 

Brain-fog – This symptoms comes and goes, but it causes the person with the autoimmune to feel a little disoriented. It can be caused by the disease or the medications.

Depression – Finding out you have a debilitating, chronic illness that you will deal with for the rest of your life is depressing. Then you add medications that can cause depression to the mix and most with autoimmune diseases suffer some degree of depression. 

Isolation – while this is not a direct symptom of the disease or medications, it is a result of not being able to fully participate in life. We do go on vacations, to family get-togethers, etc as much as possible, but for the most part, we spend a great deal of time alone.

The next time you see someone using a wheelchair or scooter, even if they can “obviously” walk, keep in mind, while they may walk a little ways, walking the entire park, store, mall, etc may be overwhelming due to the fatigue and pain.

Try to imagine living your life with a bad case of the flu. Every. Single. Day. You ache all over, feel exhausted, and have fever, dizziness, and nausea at times.

Most people who get the flu go to bed, take medication, and put life on hold until they recover. Those with chronic illnesses don’t get that luxury. We must push on for our families, and because we want to be a part of life. Being absent from life adds to the feelings of depression and isolation.

Before you make the harsh comments, stop a minute and think about those who have invisible diseases. The comments about us just being “fat and lazy” do hurt. We would trade places and walk the parks, stores, etc at any time. However, we would never wish this illness on you or anyone else.