Sorry it has been so long since I have checked in. Things have been totally insane around here. We have partially moved, and are taking it slow trying to cause as little pain as possible for me. Usually about 1 truckload every few days is all I can manage. I also had surgery on my right hand. It was an A1 pulley release on my thumb, index, and "long finger". What a pain since I am right handed. Thankfully the triggering is not an issue there anymore. I am still on 20mg of MTX weekly, and just completed week 5 on Enbrel.
Here is my current delima. I have always had bum knees, and have had 6 knee surgeries ( 3 on each), with the last surgery on each done about 10 years ago or so. Needless to say, I always have knee pain, however, the last 6 months or so, my left knee has been getting worse. It is always swollen, does not like to bend very far, and yet it cannot stay straight. Last night I also noticed it was quite hot. I have been in enough pain this past week, I have contemplated going to the ER for help with the pain. My question is, how do you know when to give the meds time to work vs going to an ortho to have it checked out? My films from the Rheumy last summer showed some arthritic changes, but I am no where near bone on bone (or at least I wasn't at that time). Since being diagnosed with PsA last July, I have been unsure of things that I would not have struggled with before, my knee being the prime example. If it had hurt like this before July, I absolutely would have had it checked out. Now, I am so unsure. If it is the PsA there will not be much anyone can do. I am so far overweight they can't do a knee replacement unless I loose some. Usually my meds do help a very small degree. Most of the time they take it from unbearable to barely tolerable.
My mom and dad are pushing me to see ortho since they think it needs replaced (i was told at 18 i would need both replaced by 30, and I will be 39 this year). Hubby thinks I need to give the meds time time to work. I'm in enough pain now, I am confused about making a choice. Something has to get done, but do I go thru Rheumy or ortho?
Sorry if this doesn't make much sense, I think I am beginning to ramble from lack of sleep.
Hi Mady and welcome back. We know PsA can move into joints that have osteoarthritis. When that happens waiting for the meds to work is the best plan. You should know at 3 months whither the Enbrel is going to work enough for you. I would then discuss it with your Rheumy. He/she will then have an idea if the Enbrel will be enough or if surgery is indicated and will send you to Ortho if needed. I hope it helps and I will keep you in my thoughts and prayers.
Definitely call your rheumy. It may be appropriate to do a short course of steroids to quiet down your knee while you are still waiting for meds to fully work. Yes, you could go to the ER, and you would likely get pain meds, but that's not really the problem. The problem is that your knee is very inflamed.
You would go to the orthopedist when you need further action, ie surgery. But that doesn't sound like it's now.
It sounds like you're recovering well from your hand surgery. Three fingers at once. Quite impressive!
Hi Mady, I agree with Stoney that perhaps a short course of steroids or even a steroid injection into your knee might be the way to go while you wait for the Enbrel to kick in. It might be in the end that the knee does need replacing but some steroids might buy you the time to be certain that the damage is beyond any improvement the Enbrel can offer.
Our line of thought is very similar. I keep thinking I should wait and give the meds more time to work. I do have an apt with my Rheumy in 2 weeks. My poor knee will definitely be a topic of conversation. I am lucky to have such an amazing Rheumy (even if he is 2 hours away), I also have found a great ortho locally. They worked closely together during my hand surgery and recovery. The ortho also knows this will likely be a long relationship.
michael in vermont said:
Hi Mady and welcome back. We know PsA can move into joints that have osteoarthritis. When that happens waiting for the meds to work is the best plan. You should know at 3 months whither the Enbrel is going to work enough for you. I would then discuss it with your Rheumy. He/she will then have an idea if the Enbrel will be enough or if surgery is indicated and will send you to Ortho if needed. I hope it helps and I will keep you in my thoughts and prayers.
I sent an email to rheumy, and he usually answer's within 24-48 hours. Oh how I hope I do not need the steroids. I have finally gotten my skin in control and on the mend from the hand surgery. I was hoping the inflamation would calm down once nice weather happened, but that was a no go. I do not want to go to the ER, ours is a glorified band aid station, and I also do not want to go down the road of narcotics yet (although if i thought they would help right now, I would be happy to take them).
Since I have had so many knee surgeries in the past, I have learned the symptoms and pain that generally lead me to a surgery and this pain is very different. This is what has given me the idea to talk to the rheumy. It sounds strange, but it is my parents that are pushing me for a dr apt. We just moved in with them (primarily to make life easier on my and hubby) but it makes me feel obligated to listen to them, even if they won't listen to me.
The hand surgery wasn't as bad as I thought it would be. Yes it was rough for a few weeks, but it was WELL worth it. I still have the never ending pain in the fingers, but at least they no longer lock in a flexed or extended position. I will have the other hand done sometime in the next few months.
Stoney said:
Definitely call your rheumy. It may be appropriate to do a short course of steroids to quiet down your knee while you are still waiting for meds to fully work. Yes, you could go to the ER, and you would likely get pain meds, but that's not really the problem. The problem is that your knee is very inflamed.
You would go to the orthopedist when you need further action, ie surgery. But that doesn't sound like it's now.
It sounds like you're recovering well from your hand surgery. Three fingers at once. Quite impressive!
I am doing whatever I can do so I do not need surgery any time soon. I know it will happen someday, but I am not interested in doing it for quite some time. I have already had 3 injections in this knee in the last 12 months, so I know t hey wont do anymore.
I am hoping the Enbrel will start helping sometime very soon!
Jules said:
Hi Mady, I agree with Stoney that perhaps a short course of steroids or even a steroid injection into your knee might be the way to go while you wait for the Enbrel to kick in. It might be in the end that the knee does need replacing but some steroids might buy you the time to be certain that the damage is beyond any improvement the Enbrel can offer.
I can empaphise with your dilemma having been in a similar situation. I see you say you are far overweight. The best advice I got from my doctor was when he stressed the importance of losing weight. He said the most powerful way to reduce my inflammatoryfactors was for me to lose my excess weight.((about 40lbs) As well as increasing the inflammation it reduces the efficacy of the drugs, including Enbrel, because they simply had more bulk to deal with, with the increased weight to dose ratio. I was also hyperglycemic and had high blood pressure.
I tried numerous ways to reduce my weight but kept failing. But since being on an alternate day fasting diet I am losing weight, my Psa symptoms are reducing ( I have knee replacements but my left knee has been constantly swollen until now) I am no longer hyperglycemic and my blood pressure is low normal and I am able to exercise again. And my self esteem has risen. I have lost half of the excess 40lbs so I hope things will get even better when I lose the rest.
thefastdiet.co.uk/ site explains how it works.
I hope you also can find a solution soon to improve your situation.
Eating a low-carb diet (like Atkins) and eliminating grains helps with inflammation and weight loss from my experience. The best part is that it eliminates cravings !
Even better than a short course of steroids, it might be worth a local injection in that knee. Either the Ortho or the rheum can do that for you. I had one when my knees were bothering me and it worked wonderfully until my meds started working. I also got to avoid all of the steroid side effects.
Until that time…RICE… Rest, ice, compression and elevation. And, if it’s okay with your docs, add an NSAID in there too. For my knees, I really like the topical Volatren gel. It’s really nice to be able to target a certain spot with your meds if you can. If the main problem is the knee, then try to medicate just that. The systemic effects will be less taxing on the rest of your body.
Of course, weight loss is also very helpful. The best diets are those that don’t include anything radical. Those are harder to stick with over the long term and often result in regaining weight. The ADA has wonderful information on diet, and it’s a good all around diet for everyone, not just diabetics. I put all of my patients on it that need to lose weight, and most have very good, steady weight loss with improved health. They lose 0.5 to 2 pounds a week with men on the higher end of the trend. Their numbers improve as well…BP, lipids, glucose, sleep apnea, etc… All of the ADA materials are free. None of the people I work with have mentioned feeling deprived, or frustrated with the diet either. Feeling negatively about your diet is a recipe for failure. I encourage you to think about it. Remember to never beat yourself up if you have a slip up. Just wake every day committed to try and take it one meal at a time.
