Soooo after second meeting with new rheumy, he has agreed to finally put me onto enbrel (assuming the insurance company pre-approve it!)
I am so happy after a year of no real improvement and now getting more frequent flares although never at a time when I have a rheumy appointment. He has suggested also doing steroid injections in my foot. I’m worried about this as I have type 1 diabetes and also had a bad reaction to oral steroids resulting in a visit to er. He assures me that the steroids injected are not absorbed systemically and will not increase blood sugars etc… I’m not sure from the reading I’ve done whether this is true - anyone have any ideas??
I have no idea, although I have heard that it stays in the joint capsule. But my question would be: which joint(s) is the doc going to inject? It’s not like a knee – a foot has something like 33. I had and have foot pain, and I’m sure intra-articular steroid shots wouldn’t have done me much good, unless they had shot up all 9 in the mid-foot, and a few more of the remaining 24. It might work if you have one or two isolated painful joints, but I’d be skeptical if my pain were widespread.
JMHO and really, I don’t know much. I DO know that it is FABULOUS news that your rheum wants you to give Enbrel a go. That is progress, at long last!
My mom is an insulin dependent diabetic. There is some systemic absorption so you would need to carefully monitor your blood sugars for the 24-48 hours following steroid injections. She knows that she does have a rise so she ups her basal insulin rate and tightly monitors. She does get sufficient relief from the steroid injections to make it worth while.
Very kind of you to take the time to answer. My pain is primarily in my toes which are swollen and the underside of my foot so I’m guessing he will focus on these bits? So long as it only affects sugars in the short-term it is probably worth a try then!
I too am delighted that I’m finally going to get to try enbrel (fingers crossed that it’s approved). I think that they will only cover 80% and from the literature I doubt that the trillium programme will cover anything as it seems to be income tested but it’s worth the expenditure if it will work. The rheumy said that most dmards are ineffective for psa (not really heard that before) - incidentally my rheumy grew up with juvenile ra so seems to understand the issues. On a very positive note I am off on a golfing holiday soon (with drinking) and he confirmed that I am good to have 2 drinks a day - even with the mtx. My liver tests are always good and he says it’s not contraindicated at all so yippeeeeee
Ah, if there is an identifiable joint or joints, then I think it is definitely worth a try. Oh yes.
You should definitely look into Trillium coverage. There is a fairly simple calculation to see if it is feasible: once your total drug costs get to 4% of your net family income (there is a line on your income tax which they use, can’t remember the number) it is worth considering. The website will tell you which line they use.
I’m impressed with your rheumy. DMARDs do work for some, but there are also researchers who say that they do more for symptom relief than they do for damage prevention. But there is no question that the biologics do prevent damage. You may have to kiss a few frogs before you find that prince of a bio, but when they work, they work great. If you can swing it, go for it. You must be so relieved. Isn’t that a great morale booster just when you are off to go golfing! Enjoy your time. Where are you going? (I’m assuming somewhere warmer than our fair province.)
Golfnut said:
Thanks seenie and Stoney
Very kind of you to take the time to answer. My pain is primarily in my toes which are swollen and the underside of my foot so I'm guessing he will focus on these bits? So long as it only affects sugars in the short-term it is probably worth a try then!
I too am delighted that I'm finally going to get to try enbrel (fingers crossed that it's approved). I think that they will only cover 80% and from the literature I doubt that the trillium programme will cover anything as it seems to be income tested but it's worth the expenditure if it will work. The rheumy said that most dmards are ineffective for psa (not really heard that before) - incidentally my rheumy grew up with juvenile ra so seems to understand the issues. On a very positive note I am off on a golfing holiday soon (with drinking) and he confirmed that I am good to have 2 drinks a day - even with the mtx. My liver tests are always good and he says it's not contraindicated at all so yippeeeeee
Yes thankfully - although still getting golf in here - fingers crossed for another month - we are off to myrtle beach with 62 other golfers - can’t wait! Fingers crossed with insurance company - seem to be starting yet another flare today after a pretty good spell so feeling fed up, but positive! And I still have the weston hospital gurus to look forward to …
Wishing you all the luck you can have with Enbrel! What a game changer it can be and if it isn’t the right fit remember once you get to the bio stage your able to swap if needed with less hassle. We are very close in diagnosis dates so I feel we are likely in similar stages. I have had two rounds of injections done on my toe joints and they were incredibly helpful! I think I may have lost my job if I had not received the first round. I do not have the steroid sensitivity or diabetes you explained so this may be difficult decision to way out but just thought I’d share my experience. You can always send me a message if you have more questions regarding them. Just be sure if you do to set aside one to two days to kick up your feet, not just because they are tender but it also allows the medicine to absorb properly.