I was referred to a rheumy from my primary doctor and because I live in a rural area it is about a 3 hour drive to his office. I have had three appts with him and he said I have Psa and started me on Methatrexate and meloxicam with a starter does of pregnizone. He has raised the doze of mxt to 5 pills a week and because I didn't get any pain relief, he put me on Gapapentin 300 mg. Well, I still don't feel any different, no relief at all with the medications and wondered if this was normal? Another thing is that 7 years ago, I had bariatric surgery (RNY) so part of my intestines are gone. I have noticed that I have a lot of absorption problems and have anemia on and off - depending if I am on Vit B12. Has anyone else who has had RNY and not getting relief on this discussion page? What helped? Also wondered about - we have a pain clinic in our local hospital and now that I have a dx of PsA, would it be appropriate to go there then to drive 3 hours a month to and 3 hours back from the reumy? Plus I just started a full time weekday job so my time is limited during the week now too. Thanks for any comments or advice.
Hi Sis! This is good, that the rheumy has gotten you on a disease modifying drug right away. It does take time for any of these types of meds to kick in, so you may find that it could take a few months to really start noticing relief. Pain relief may be necessary, but I wouldn't jump to it. Making lifestyle changes that include gentle exercise and stretching, and just waiting out the meds, may be all that's necessary. Is your primary care doctor willing/able to work with the rheumy to monitor you?
There are several different treatments for PsA. If MTX doesn’t work for you ask for another. You also have to consider that pain from permanent damage is not going to go away with any of the drugs we take for PsA.
There are also other markers for disease activity besides pain. The Rheum will be looking at those as well.
I'm just thinking about the timelines here, Sis. How many weeks have you been on methotrexate? First you have to work up to a dose that is effective for you (five pills isn't a huge dose) and it can be three or four months before you feel a difference. The change will be gradual, which is the case with most of the disease modifying drugs that we take. Discouraging, I know. We've all been there.
I'm glad that your rheumie has you on some other meds to address the pain while you are waiting for the mtx to work. The idea of the mtx is to slow the disease process down. The other drugs and anything the pain clinic could do for you won't slow your PsA down, and that's what has to happen to prevent joint damage. So I guess I'm saying yes, you need to be seeing your rheumatologist because only a rheumatologist will give you the disease modifying drugs which will, hopefully, spare your joints.
Does your rheumatologist know that you've had absorption problems since your RNY? I don't know where, exactly, the mtx is absorbed, but you might ask about bypassing your digestive system all together by using injectable mtx. There are fewer side effects with the injections, and some people think it works better.
As for your bypass question, it's a good one, but it may not get as much attention on this post as it might if you make a separate (new) post with something about bariatric in the subject line.
Back to the drugs, there is a lot of information in The Newbies Guide (click on the shortcut in the green band above). Or have you found that section yet?
Hi Sis! It's great you're seeing a rheumatologist and are on disease-modifying drugs (mtx). Your number one priority at the moment is to slow down/stop the PsA. Unfortunately, the meds can take months to work. Have you discussed your bariatric surgery with your rheumatologist? If not,it would probably be worth a call to your rheumy to discuss that and what it means for your med absorption. Injectables may be better than oral meds in your case, and it's definitely worth a discussion with your rheumy.
I’ve been on MTX for two years. My Rhumy gradually increased the dosage to eight, every week. It’s helps a great deal. My Rhumy put me one Humira. After three months, I experienced great pain in my hands and wrists. I started to get infections,and the fatigue was every day. My Rhumy took me off Humira and I just got it out of my system. The MTX is working now. You have to stick with it for it too work. Remember, that what you eat makes a big difference!
Thanks for the advice - it was great and I hadn't seen the guide yet. Good idea about a new thread about bariatric people.
Seenie said:
I'm just thinking about the timelines here, Sis. How many weeks have you been on methotrexate? First you have to work up to a dose that is effective for you (five pills isn't a huge dose) and it can be three or four months before you feel a difference. The change will be gradual, which is the case with most of the disease modifying drugs that we take. Discouraging, I know. We've all been there.
I'm glad that your rheumie has you on some other meds to address the pain while you are waiting for the mtx to work. The idea of the mtx is to slow the disease process down. The other drugs and anything the pain clinic could do for you won't slow your PsA down, and that's what has to happen to prevent joint damage. So I guess I'm saying yes, you need to be seeing your rheumatologist because only a rheumatologist will give you the disease modifying drugs which will, hopefully, spare your joints.
Does your rheumatologist know that you've had absorption problems since your RNY? I don't know where, exactly, the mtx is absorbed, but you might ask about bypassing your digestive system all together by using injectable mtx. There are fewer side effects with the injections, and some people think it works better.
As for your bypass question, it's a good one, but it may not get as much attention on this post as it might if you make a separate (new) post with something about bariatric in the subject line.
Back to the drugs, there is a lot of information in The Newbies Guide (click on the shortcut in the green band above). Or have you found that section yet?
I actually am having some hand pain just on the MTX... It isn't bad just annoying and hope it is just a side effect that will go away as soon as my body gets used to the meds. Thanks for the great advice!
Tired of pain said:
I've been on MTX for two years. My Rhumy gradually increased the dosage to eight, every week. It's helps a great deal. My Rhumy put me one Humira. After three months, I experienced great pain in my hands and wrists. I started to get infections,and the fatigue was every day. My Rhumy took me off Humira and I just got it out of my system. The MTX is working now. You have to stick with it for it too work. Remember, that what you eat makes a big difference!
You mentioned hand pain. It’s not likely a side effect. Rather, you may be getting new joint involvement while waiting for the meds to work. That’s not unusual. It’s tough waiting for meds to start working, but you’ll likely start to notice over the next month or two that there is some improvement. You are in the “gap” right now.
Sis said:
I actually am having some hand pain just on the MTX… It isn’t bad just annoying and hope it is just a side effect that will go away as soon as my body gets used to the meds. Thanks for the great advice!
Hi Sis, I have malabsorption issues - not through bariatric surgery but other. The best I could find in my research is that they don’t seem to really know what the effect is on methotrexate - given there is a readily available injected form I’d definitely discuss it with my Rheumy. It is also worth talking to whoever your specialist was who managed the bariatric surgery process about not only MTX, but other drugs - there may be some evidence that NSAIDs have a higher risk in bariatric surgery patients for example - but s/he will know best.
Thanks for all the good advice. I wonder if this is something new - PsA and RNY.... I called my RNY office and talked with the nurse practitioner and she pretty much blow me off. She said that they don't deal with that and to ask about it with my rmy. I said I just wanted to know about absorption of medications after RNY and she again said to call rmy. Does anyone know of a WLS doctor who would be willing to talk with me about absorption issues and how it affects PsA? Thanks for all your advice!!