I've been doing pretty good of late. I've had plenty of energy, but my pain and joint inflammation seems to have been on the rise in the last four-six weeks. I've been getting stiffer and stiffer at night. I wake up quite a few times feeling pain in the joints in contact with the mattress but also more pain in the joints that need to move in order to roll over (hips. back, knees, elbows). It seems that the Humira is definitely doing something as my energy levels are good, but it isn't doing much to help pain and stiffness.
I emailed my doctor about the option of adding another DMARD. His response was to start on 5mg or Prednisone per day (a VERY small dose) and see if that helps. His reluctance to add a DMARD is that it would take quite a while to see if it had any effect. I guess his standard "cheat" is to put me on Prednisone, and if it helps then also add a DMARD. And after six-eight weeks to take away the Prednisone and see if my symptoms stay stable.
Does anyone else's rheumatologist use Prednisone as a stop-gap like this?
My Rheumy has never done it that way but it may be the differences between doctors. My Rheumy has used a short taper to bridge me while waiting for DMARDs to work. She started my mtx at a very small dose and then increased slowly. It may be one of the reasons I have not had much side effects on mtx. I now inject it and sometimes feel icky the next day or two but not always. There are different "protocols" with different doctors but each can be effective with different patients. I do not tolerate prednisone very well but I do tolerate mtx pretty well. Different patients have different reactions but rarely does it mean the doctor is "wrong' they may just be trying a different route to the same outcome, controlling symptoms and disease progress!
I hope you feel better Jane. It has been a tough winter for me so far. Let's hope it lifts soon!
My rheumy put me on 2.5mg pred, which is laughable, and then upped it to 5 a day. I can't take NSAIDS, so it's the only anti-inflammatory I take, and it does make a difference. Seeing as it's my only choice with my current Remi dosage/schedule and other medical issues, it's worth it for me.
I hope you find something that gives you relief soon!
My Rheumy has a standing prescription for dexamethasone for me to take whenever I feel like my flare is worse than usual. She gives them to me 30 pills at a time, knowing that I will take 1 a day for 7 days, then 1/2 a day for 7 to taper off...and that I am really careful about using them because I KNOW what will happen when I take them. My GP likes to give me Prednisone, but I end up with all kinds of hinky side effects with that one, whereas I tolerate the dex pretty well. Don't really know why there is a difference, but I know that on Pred I get flushed face, anxiety, moodiness, and depression. The Dex gives me just wee bit of flushed face, but easily dealt with, and none of the other side effects.
That's good info, tmberwolf. Like you, my Dr. encourages that I keep back prednisone for flares and have his OK to take at will (because he know I hate the stuff and will be really careful). Didn;t know about dexamethasone. Will have to research. I took prednisone 20mg for about 8 months. I hated it at forst (anxiety, racing thoughts, MASSIVE impatience etc.) but those side effects went away after a while. They re-emerged when I tapered and I had to go back up in dosage a couple of times during my taper due to bad reactions.
Like I said, I really HATE this stuff but it helps me so I like it too. Me+prednisone="it's complicated"
i guess I'm happy because he uses it to support my body when I'm not doing so great. I know the NSAIDs don't work well for me and that the DMARDs take a while to kick in, so I undertand why he does it. Plus, I don;t see him again until Feb 12th so I understand the stop gap until he can assess me properly and make a determination of the right course of action. But, like I wrote to tmbrwolf, I hate and love the stuff in equal measure. It really messes up my body and the tapers are hell. But while I'm taking it my pain is always lessened, any inflammation is reduced and my energy is off the charts (in the "I have so much I don't know what to do with myself" way--which isn't always great).
sybil said:
Yep, I took Prednisone for 3 months as a stop gap when I first started on Mtx. Are you happy with this strategy though?
when I DO get put on Pred (rather than the Dex), I end up with 20 mg 2x a day for a 5 day run each time. YUCKY! I'm in kind of a weird spot since my Rheumy is currently in TX (about 750 miles south of me), and my GP is in OKC. So I go to the free clinic whenever I need to in OKC (he gives me some scripts for free, too, which is a big help), and only see my Rheumy about every 6-8 months. My doc here in OKC does all my bloodwork, gives me my allergy med, any Prednisone I might need, antibiotics if necessary (though he is pretty stingy with those) and (if I decide to switch from amitryptaline) gabepentin. These are regular meds that the clinic stocks to give out to people in need. If I switch to injected MTX, I can get all of my injecting supplies there for free as well, which they stock for insulin-dependent diabetics. They are also the ones who will be infusing my Remicade. For now, though, I have the dex so I don't have to go back on the Pred for a while (gladness!)
I think the shot works differently than the daily low dose oral prednisone. I'm OK with taking the pred for a while. I saw my GP yesterday and she ordered a bone density scan which I'm having on Thursday just to be sure I'm not suffering any ill-effects from predisone use (because I took 20mg for about 8 months in total).
Sorry you're in a bind waiting for your meds to kick in. Even if you think your meds aren't as efficacious as you had hoped it is amazing how much they actually do for you (which you don't realize until you stop taking them). Chin up. ANd, yes, impressive Maths skills ;)
sybil said:
Just a thought - might a steroid jab in the backside be another option?