R.A. after RNY
I have read many posts about R.A. after gastric bypass. I never thought it would have anything to do with my RNY. My rheumatologist put me on methotrexate pills and after 12 weeks she took me off because I was getting worse. She wants me to start methotrexate injections in 2 weeks. I am allergic to sulfa drugs so she said I can't take anything else. I worry about the bad side effects of methotrexate. Anyone have any other ideas? I am tired of being in pain all the time. The mornings are worst, but now it is attacking my back. Thanks for all your help.
I am sorry that you are suffering. I too have RA and the mornings are the WORST! Do you exercise at all? Even though it is very hard, I try to move as much as possible. It seems to help somewhat. I have the DS so I am not much help on the drug front. I hope that you find the answers that you need.
AmandaSW 269 CW 135.6 GW 140
Heather:
When you read about the side effects of methotrexate it is important to realize a few things. Firstly, they are a list of "potential side effects". The vast majority of patients taking MTX never get any of them. Also, many of them listed are done so because they are seen mostly when high doses of MTX are used in patients (for example to treat cancer) rather than the low doses used to treat RA. The most common side effects are mild and reversible with using lower doses if and when the do occur. MTX is considered the gold standard and first drug of choice for treating RA because after its being used for 30 years now by rheumatologists, it comes out way ahead of the pack as far as safety combined with its effectiveness for many patients.
In addition, you have to compare the disease to the treatment. While the vast majority of patients taking methotrexate will not get any side effects from the MTX; RA itself can be devastating across the board causing the pain, stiffness, difficulty with doing one's daily activities. Over time, it is a crippling disease. Not only that, it is a deadly disease. Patients with RA die about 10 years younger than their peers because of the systemic inflammation causing early onset cardiovascular disease. Recent studies suggest that patients being treated aggressively to get their disease under control are most likely having less problems with these complications of RA (to include heart disease). When I did my rheumatology fellowship in the early 90s, I remember our waiting room full of folks in wheel chairs and crippled up. These days, it is markedly less so, in fact, the orthopedists tell us they are not doing nearly as many surgeries on RA patients as they used to because of the much better treatment these days.
It is just very important to make sure that you do get your blood tests done every 4-12 weeks on the medicine (to make sure your liver enzymes and blood counts stay OK), that you drink very limited alcohol if any, and that if you do get any side effects (like diarrhea, stomach upset, rash, hair loss,etc.) that you let your doctor know. Also, your doctor should also have you on either folic acid or leucovorin to prevent side effects, so make sure you are also taking one of them. These days with so many really good medicines available, a large percentage of patients are able to get under control and be in "remission" on medications. If MTX doesn't do so, your doctor may talk to you about adding one of the biologics to your regimen.
Best wishes!
When you read about the side effects of methotrexate it is important to realize a few things. Firstly, they are a list of "potential side effects". The vast majority of patients taking MTX never get any of them. Also, many of them listed are done so because they are seen mostly when high doses of MTX are used in patients (for example to treat cancer) rather than the low doses used to treat RA. The most common side effects are mild and reversible with using lower doses if and when the do occur. MTX is considered the gold standard and first drug of choice for treating RA because after its being used for 30 years now by rheumatologists, it comes out way ahead of the pack as far as safety combined with its effectiveness for many patients.
In addition, you have to compare the disease to the treatment. While the vast majority of patients taking methotrexate will not get any side effects from the MTX; RA itself can be devastating across the board causing the pain, stiffness, difficulty with doing one's daily activities. Over time, it is a crippling disease. Not only that, it is a deadly disease. Patients with RA die about 10 years younger than their peers because of the systemic inflammation causing early onset cardiovascular disease. Recent studies suggest that patients being treated aggressively to get their disease under control are most likely having less problems with these complications of RA (to include heart disease). When I did my rheumatology fellowship in the early 90s, I remember our waiting room full of folks in wheel chairs and crippled up. These days, it is markedly less so, in fact, the orthopedists tell us they are not doing nearly as many surgeries on RA patients as they used to because of the much better treatment these days.
It is just very important to make sure that you do get your blood tests done every 4-12 weeks on the medicine (to make sure your liver enzymes and blood counts stay OK), that you drink very limited alcohol if any, and that if you do get any side effects (like diarrhea, stomach upset, rash, hair loss,etc.) that you let your doctor know. Also, your doctor should also have you on either folic acid or leucovorin to prevent side effects, so make sure you are also taking one of them. These days with so many really good medicines available, a large percentage of patients are able to get under control and be in "remission" on medications. If MTX doesn't do so, your doctor may talk to you about adding one of the biologics to your regimen.
Best wishes!
Don
Interesting...developing RA after WLS...I hadn't heard about that....
I have been diagnosed with RA for over 10 years. I was doing great until my divorce. After my divorce....I gained a lot of weight, and got so stiff and sore that i was having trouble excercising. Became a negative feedback loop...the heavier I got, the worse I felt, couldn't excercise, and i became heavier. Not to mention being on and off of prednisone didn't help matters. That is why I looked into weight loss surgery.
I too am allergic to sulfa drugs, so my options are also limited. I take a combination of Enbrel and methotrexate. I don't like taking the methotrexate, but my rheumatologist says the combination is really critical to preventing joint damage.
I have had great luck with the Enbrel. You get used to giving yourself shots, and it is better now that there is a once a week option. Other drugs like Enbrel are Humira and Remicade. I would check with our doc to see if they are an option for you.
Oh, and the poster who said that you should move and excercise as much as you can is spot on. The more excercise you get the better you will feel. Start slow, and progress because excercise is really helpful...but if you overdo it you will be sorry for a couple days.
Good luck!
I have been diagnosed with RA for over 10 years. I was doing great until my divorce. After my divorce....I gained a lot of weight, and got so stiff and sore that i was having trouble excercising. Became a negative feedback loop...the heavier I got, the worse I felt, couldn't excercise, and i became heavier. Not to mention being on and off of prednisone didn't help matters. That is why I looked into weight loss surgery.
I too am allergic to sulfa drugs, so my options are also limited. I take a combination of Enbrel and methotrexate. I don't like taking the methotrexate, but my rheumatologist says the combination is really critical to preventing joint damage.
I have had great luck with the Enbrel. You get used to giving yourself shots, and it is better now that there is a once a week option. Other drugs like Enbrel are Humira and Remicade. I would check with our doc to see if they are an option for you.
Oh, and the poster who said that you should move and excercise as much as you can is spot on. The more excercise you get the better you will feel. Start slow, and progress because excercise is really helpful...but if you overdo it you will be sorry for a couple days.
Good luck!
I have been battling RA for over 10 years now....I have been on the methotrexate injections for about 5 years now and also take 2 plaquenil pills a day....the heavier I got the worse I felt....I am happy to say however, that since my surgery, I have not taken a single injection, and I rarely take my daily pills....I am going to go to my doctor and get some blood work done to see if I actually am still considered an RA sufferer. I joined the gym a week ago and I am feeling Grrrrreat!
Within 3 weeks after my RNY surgery I started having RA symptoms. At the time I thought that I wasnt getting enough calcium. Within 3 months I had full blown RA all over my body. Started with my feet, and ankles then my knees, hands, finers, elbows, and even my jaw! Its been 2 years now I have have had the worst time with RA. Ive been on enbrel, methotrexate, humara, plaquenil, and of course the only thing that gives me relief, prednisone. My husband and I started trying to conceive and I was only allowed to take plaquenil and prednisone. It took 14 months and alot of loss and heartache before conceiving our second. Im now 6 months pregnant and having the worst time with RA. im now up to 4, 4mg prednisone just to get through the day. Honestly the prednisone hasnt caused any weight gain and ive actually been able to still lose while on it. Of course its been hard to get down to my goal weight but im at a much healthier weight now.
Ive never been told my RA had any relation to having my surgery, even though I didnt have any symptoms or signs of it until right after my surgery.. hmm something to think about!
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