Naproxen “eats holes” in my stomach, but everybody doesn’t have that SE from it. I couldn’t tell you what Meloxicam is. I really didn’t follow the usual protocol because I would say my start of PsA was in my fingertips and it was more discomfort than hard pain and I didn’t want to take pills around the clock that would affect my whole body for some discomfort in my fingertips. After several years of increasing pain and symptoms–finally to the point of too many pain locations to deal with, I was able to go on Enbrel, bypassing the Nsaids and DMARDS.
Did your doctor try prednisone yet? I don’t remember from your past posts/discussions if you’ve have prednisone. I think if prednisone helps, it’s an indicator that your pain is from inflammation. I guess Nsaids can help that, if you can tolerate them, but there’s so much more to PsA. There’s no way Nsaids will help the fatigue and weakness you may have.
Good luck! I hope your stomach can handle this! Taking food with it should help.
Are you aware of the protocol for the NDAIDs before moving to DMARDs ? - I’m just wondering if this is typical.
I haven’t had a diagnosis yet so basically I have been given this prescription to follow for 6 weeks until we get the test results.
The idea is to see if this dose has any noticeable effect on the inflammation.
I have been taking 400 mg of ibuprofen for about 4 months .
I really don’t know if it has any real effect
Basically there is typically more inflammation/stiffness in my fingers in the morning which lessens throughout the day but I don’t really know if the NSAIDs are effecting this.
I have swelling and stiffness in the DIP joints, wrists and the tendons in my hands
It’s fairly moderate- not too debilitating .
The swelling started in January of this year and the joint stiffness in July.
Actually the swelling has gone down in the last 2 weeks for some reason
Until 2 weeks ago I wasn’t able to fasten my watch or wear my ring due to swelling but now I can.
Aside from my hands I have SI joint pain. This is really where most of my discomfort lies
The pain varies from mild to quite severe when I have a flare.
I’m more interested to see what if any effect it has on the SI joint.
I have to say that I’ve never heard of someone taking 2 NSAIDs at the same time. That’s really what the doctor told you to do?!
Doctors can start you off on an NSAID, DMARD, or a combination. I started off on just the NSAID, so did my husband, and so is my daughter. Three different rheumies, although I did have my husband switch to mine. She’s so superior to who he had seen.
If you are continuing to have morning stiffness that lasted, swollen joints that persist, etc, this needs to be communicated to your doctor. It will likely get you on a DMARD faster.
That makes sense. Which ones work well and are well tolerated is (not surprisingly) personal. My mom took relafen for years. I took it for a month with virtually no improvement. Now I take daypro. My daughter is taking meloxicam, and I’m not sure what my husband is taking.
That is the new protocol and it makes sense. Here why:
Meloxicam is a cox2 inhibitor and is generally MUCH easier on the gut. It is also a time release.
Naproxen is a Cox1 but is not a time release so you get a big bang
By taking the two you get the advantage of the higher dose NSAIDS, but gentler on the gut and a more even dosing (you shouldn’t take the two at the same time but stagger the dosage a few hours IMO)
I would bet a nickle based on the testing you have said you have had so far that back pain is an issue (or at least the physical exam was when the put you up to a wall and measure the distance form various parts of your back to the wall and then do some math) has them thinking a spondylitis form of arthritis as this also the protocol for ankylosing spondylitis which is now considered PsA.
In any event this aggresive NSAID therapy is indicitive of a good doc who wants to work you throught the “step therapy” as quickly as possible.
Unfortunately I can’t help you with which one is more effective, as I had an allergic reaction to meloxicam (which is considered to be extremely rare) prior to onset, so have never tried it.
With regard to the protocol, others might weigh in here (@tntlamb ), but I was under the impression that the NSAIDs first protocol is a very old protocol primarily used for Ankylosing Spondilitis, and still used in some places for that (eg here in Australia), but it’s not in the clinical guidelines for PsA.
We have some of the most conservative guidelines in the world, but do not do a NSAID trial prior to DMARDs for PsA because there is no evidence it slows disease progression and damage (though it may alleviate symptoms somewhat).
The reason Australia still uses it for Ankylosing Spondilitis is that there is no real evidence traditional DMARDs work for that either. And, of course, the Australian government foots the bill for treatment. So Skipping straight to biologics (which I’m not sure how good the evidence is), isn’t an option here.
It sounds like you are still in diagnosis. Did the Rheumy seem reasonably comfortable with the idea of PsA, or was he talking about Ankylosing Spondilitis as well? Did they do any X-rays of those SI joints?
I wasn’t told to alternate the 2 drugs but rather begin with one take it for 2 weeks and see if it has any effect and if not try the other.
That is of course as long as I can tolerate it.
I’m actually going to contact them again just to be sure I understood correctly.
Anyway I guess that this is all just basically to see if a higher dose NSAID shows any measurable difference. I had up until now taken 400 mg ibuprofen.
I’m not entirely sure how to gauge the impact as the inflammation in my fingers and wrists has already decreased noticeably in the last couple of weeks for some reason .
I am interested however to see if there will be an impact on the SI joint pain.
I just received my blood test results and all of the inflammatory markers ESR,CRP and RF are normal.
If this is the case is it still necessary/beneficial to take them?
I don’t know if any of this will be helpful, but I thought I’d offer it anyway.
I’m still in the gray area of whether or not I have an inflammatory arthritis (on paper!). My Rheumy and Orthopedic Surgeon thinks it’s a slam dunk, but we can’t PROVE it yet. I’m in the United States and had to try many NSAIDs before the Rheumy would start me on a DMARD. This was because all of my bloodwork was negative (still is!), no joint damage was evident upon X-ray, and the severe damage in my knees COULD have just been osteoarthritis (again, not enough evidence to prove otherwise.)
Fast forward to Nov. 2016–my wrist was swelling for no reason, my left foot was swelling for no reason, and my 7th NSAID wasn’t controlling on-going inflammation in my knees or the recently inflamed wrist and ankle. That’s when I was able to begin a DMARD.
Lastly, Meloxicam helped me reasonably for 3-4 years (and was the last NSAID my stomach could handle after years of ibuprofen thanks to 6 knee surgeries and ensuing complications). It stopped working in late 2015 but luckily never bothered my stomach, even at the highest dosage. I ended up on Celebrex. I currently still take Celebrex daily along with the Plaquenil (my DMARD).
I’m currently having more joint swelling in my wrists. I see the Dr in Feb. She said it’s likely I may start a new medications, as apparently the Plaquenil is not doing much, if anything. I am told at each visit that changing meds is all about proving one isn’t working or more damage is occurring, while waiting for the BIG DAY when my bloodwork shows something ((ANYTHING!!!)) to prove an inflammatory arthitis.
Hi there ktel, I’m not sure exactly what the protocol is for NSAID’s, but my GP started out with ibuprophen, which had absolutely no effect, then Tilcotil (aka Tenoxicam, as near as I can figure same category as Meloxicam)… it was the first med to ever have any effect on my back pain, and believe me over the last 20+ years I’ve tried a real variety pack, even though it was minor benefit. With the Tilcotil he insists that I take Omeprazole with it, to reduce the risk of stomach ulcers (as I am on blood thinners too, and it wouldn’t be at all good to have a bleed in my stomach).
I think the fact that Tilcotil did have some noticeable effect on joint pain was an indicator that pain was inflammatory (I might be wrong about that though). Also from what I read everywhere NSAIDs can be effective for some with milder forms of inflammatory arthritis, at least as far as reducing symptoms.
As Tilcotil didn’t do enough my GP added Mtx to the mix as a trial (at that stage wasn’t accepted for Rheumy appt), and now Rheumy has added Leflunomide too… it’s a frustrating time sitting through the “wait time” to see if these things work, unfortunately this does seem to be the protocol here in NZ though.
If you start finding you have acid stomach do ask your doc/rheumy about adding some omeprazole, as a lot of NSAIDs can be harsh on the stomach.
It’s great your follow up with rheumy is only 6 weeks away… to date most of mine have been 3 monthly.
All the best, and I’d listen to tntlamb on this… he really knows his stuff
I know that it’s a difficult process diagnosing PsA - piecing together a puzzle.
I only just had my first Rheum consult so it’s early days for me.
As I mentioned my blood work was negative for signs of inflammation.
I had x rays. I don’t have those results yet but from what I understand they aren’t don’t usually show anything unless there is significant damage anyway.
I consider myself to have a mild/moderate case compared to other cases I’m reading about
It’s the SI joint pain that bothers me most although the level of discomfort fluctuates quite a lot
My main concern is how things may progress if untreated
Things are manageable right now but I don’t want to risk things deteriorating
That being said, I also want to fully understand the pros and cons of taking the NSAIDs before I start
I’m particularly interested in the mechanism.
I don’t appear to have much inflammation right now so I don’t know how they would help especially in relation to the SI pain.
I will be researching more but just wanted to get some input here.
I’m edging towards starting on the Meloxicam first and monitoring from there.
Naproxen needs omneprazole to stop the stomach issues so I wouldn’t take it without that at all. Although you can get both in the same tablet, it depends on how your pharmacy deals with it. I haven’t tried the other but do Naproxen and I find it ‘comforting’. It doesn’t get rid of pain but without it I certainly feel more uncomfortable. However as a DMARD sulfalsalazine is working for me, in the New Year I’m going to try and decrease my Naproxen - just to see. But I’ve been taking it for the last year and a half, twice a day.
That is frustrating … and not a great approach. Not everyone with PsA has raised inflammatory markers and there are no blood tests that prove PsA. I wish I had my Gladman & Chandran book to hand - ‘Psoriatic Arthritis’. (Moved house 16 months ago and all my books are still in boxes). I’m pretty sure that PsA ‘bible’ states as much.
You could do a little research about this (including using the search feature here) and then, if and when you feel convinced that your doctors should not be taking this approach, you could tell 'em that in the nicest but most assertive way you can muster!
Hi Sybil,
I truly appreciate the honesty I get from you all here. A couple of weeks ago, Lamb said something similar in one of my recent posts, and I agree my next appointment needs to be a demanding one.
I am simply tired of the wait-and-see approach. I feel like I have all of this information, and it’s going nowhere because “I’m just not bad enough yet, or consistently.” I had a knuckle swell today for no reason, and I know the knees aren’t stable. I’ve had too many years of feeling the negative changes coming in my knees and how that limits my movement, the length of time I can stand, and the amount of swelling that remains before the bottom falls out again.
I know I’m scared to switch Drs, especially knowing this practice and specific Dr was so highly recommended. I saw the PA the last 2 times and was told I get to see the actual Rheumy in Feb, as that PA is leaving. Apparently the Dr wants to see all patients before she dumps us off to her new PA. I figure this is my last-ditch effort to get different treatment. If that fails, I think I have no choice but to pursue another opinion.
Thanks again for helping me to see this and ADMIT it to myself. You guys are just wonderful her.
@lisarockgirl4 - photograph all those swellings that can pop up and then disappear, on your phone and keep them to show your doctor. I did that as a little bit like you I was swollen one week and not the next and bits of me ballooned and then went down and I thought no one would believe how bad I could get at times. However later sitting in the consultant’s office with all body parts being far too normal, I took the doctor through the photos and the effect of that was powerful. I walked out of there feeling vindicated finally. I did then switch doctors anyhow but for that appointment I felt I proved my case.
I took Meloxicam for 2 weeks and didn’t notice any benefit.
I then took Naproxen for 5 days- at that point I discontinued it due to some gastric issues. The issues were moderate but since I wasn’t getting any benefit decided to discontinue
I have now resumed the ibuprofen again - restarted yesterday at 800mg .
I’m not sure what sort of effect I should anticipate when taking these but basically I don’t discern any benefit from any of them.
I have also gone a few days when taking nothing at all and felt the same as when taking NSAIDS
My discomfort level currently is moderate and mostly related to my SI joint.
Over the past year the level of discomfort has fluctuated from mild to quite intense when I have had flares
However I get the general impression that this more the natural ebb and flow of the issue rather than being related in anyway to the NSAIDs.
From what I understand it is not recommended to take NSAIDs over a long term period especially at high dosage and that it is usually seen as a bridge before initiating other medication such as DMARDs.
I’d appreciate any observations/feedback on this from others here
I have an appointment on Thursday with the Rheum and am preparing my questions and observations .
My main focus is going to be on interpretation of the test results , the next steps in the diagnostic process and the use of NSAIDs.
A couple of weeks ago, Lamb said something similar in one of my recent posts, and I agree my next appointment needs to be a demanding one.