Re: medication help : here's some ideas...

[Guest guest]

Dear ine and Group:

I'm sure someone has given the " lowdown " on RA medications in the

past. But since you asked, I thought I would tell you a little of

what I know (keeping in mind I'm not an MD); and if others would like

to give their thoughts, please do so. I would also like to pass along

a nice website that people with all kinds of diseases find helpful:

http://www.remedyfind.com

That site is a good place to find out the " anecdotal truth " about

prescribed meds. You'll find out what others thought was helpful or

not.

Anyway here's my lowdown for RA meds:

DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMADs):

These medications should be the very FIRST line of defense because

they can actually slow the erosive course of RA when brought on EARLY

in the disease.The drugs in this catagorie include:

methotrexate (usually 7.5-25mg weekly by mouth or injection)

Gold (25-50mg by injection every 1-4wks OR 3-6mg by mouth daily)

sulfasalazine (2000-3000mg daily)

hydroxychloriquine (200-400mg daily)

penicillamine (250-1000mg daily)

cyclosporin (1.5-2.5mg per kg of your body weight daily)

cyclophosphamine (1-2mg per kg of body weight daily)

leflunomide: this is showing better symptom control than

methotrexate and slows joint corrosion. It also is less

destructive on bone marrow. If you don't get good results

within 4-6wks of starting this med, then it probably isn't

going to work for you. (same as w/methotrexate)

**Kidney and liver function should be monitored w/all of the drugs

in this classification**

BIOLOGICAL RESPONSE MODIFIERS (BRMs):

These medications work by changing the chemical reactions on the cell

surface of very specific cells. These drugs are usually given after

it's determined that the DMARDs are not working. They are generally

quite expensive. Given only by injection, these may be difficult for

some patients to self-administer due to decreased hand strength or

coordination.Drugs in this class include:

etanercept and infliximab

NON-STEROIDAL ANTI-INFLAMMATORIES (NSAIDs):

Both OTC (over the counter) and prescription analgesics that also

decrease inflammation.These drugs do not slow down disease

progression, in fact may even delay early diagnosis of RA, and

therefore delay early start of the DMARDs. These drugs can be used in

conjunction with DMARDs or BRMs -but never should be used by

themselves with the diagnosis of RA since they do not

actually " treat " the disease -only the symptoms!There are many OTC

and RX NSAIDS. Here are just a few:

Ibuprofen

naproxen sodium

** These medications may cause or increase your risk for ulcers

and/or bledding of the GI tract, and kidney impairment because they

are " COX-1 inhibitors. " -1 inhibitors decrease prostoglandins in

the stomach and kidneys. (prostoglandins are one cause of menstrual

cramps-that's why ibuprofen helps so much!) The " -2 inhibitors "

that came in vogue -and went back out again- did not cause a decrease

of prostoglandins, that's why they were easier on the stomach.

Unfortunately, they were hard on the heart!**

CORTICOSTEROIDS:

These medications have strong anti-inflammatory properties, and are

used in the treatment of many diseases where inflammation is a

problem. These " steroids " as they are called has saved many lives

such as in the case of asthma or when there is increased pressure in

the brain from swelling.There are several types of corticosteroids,

but the two major medications used in RA are:

Cortisone- this is injected directly into the affected joints

prednisone/methylprednisolone- this is an oral " steroid " usually

given for short durations in moderate to large doses, then

quickly tapered down. Also given in small doses for indefinite

periods.Often used to minimize disease activity until the DMARD

begins to take effect.

**Long-term use with even low doses of oral steroids can have severe

consequences! Osteoporosis and " avascular necrosis " (which means

literally " without circulation, tissue-death " ) are just a few. It's a

good idea to get a base-line bone density study prior to going on

long-term oral steroids, and then check periodically (every 6 months-

2 years) to make sure there is no bone destruction.**

ANTIBIOTICS:

Interest, and therefore use, of antibiotics wax and wane in the

rheumatalogical field. There have been some studies showing the

medication " minocycline " as a useful therapy in mild RA. To my

knowledge, this drug has not been shown beneficial in severe or

advanced RA.

DRUGS ON THE HORIZON:

Research into the causes of inflammation in RA has caused some

interest in medications that traditionally have been used to treat

other diseases, or in compounds found naturally-occuring in the human

body. Some of these medications or compounds are:

calcitonin (down-regulates monocyte or white blood cell function)

rifampin (a drug used to treat tuberculosis; acts on RNA

synthesis)

retinoid compounds (has multiple effects on biological systems)

anti-tumor necrosis factor (TNF) monoclonal antibodies (delays

abnormal cartilage and bone growth)

OPIOID PAIN MEDICATIONS:

I have included these last because they are not really medications

used in the " management of RA; " although they can be, and generally

are, very useful for " pain management. " :

tramadol -not a true opioid, but a " distant cousin " ; works on the

central nervous system. Like opioids, can develop a

tolerance over time, and there is abuse potential.

hydrocodone -(as in Lortab,Lorcet,Vicodin, Norco, etc)- generally

used for short periods of time, i.e., 1-4 wks or for

" break through " pain when using a long-acting opiate

methadone- often a " first line " or " drug of choice " in long-term

pain management. Tolerance is possible, as with any

opiate, but abuse potential not as high.

oxycodone - (as in Roxicodone, Percocet, Percodan, Tylox, etc.)

Often used for severe pain for short duration or as

" break through " pain med when using a long-acting

opiate such as oxycontin or ms-contin. Tolerance occurs

and potential for abuse high in certain individuals

oxycontin, ms-contin - two different opiates used in long-term

pain management. Tolerance occurs, as with any

opiate,and abuse potential is high in certain

individuals

fentanyl patch - (as in Duragesic patch) An adhesive patch placed

on the skin and replaced every 48-72 hours. Provides

continuous opiate administration

** Obviously the risks of opiate use has to be considered when using

long-term. The " addiction " potential that concerns many chronic pain

patients is real, but not as dramatic as you might imagine. Very few

people who genuinely need pain management become " addicted " to their

medication. It's important to realize that " addiction " is not the

same as " tolerance. " EVERYONE will become tolerant at some point!

This is the nature of opiates. All that means is that it will take

more medication to obtain the same pain relief. This by no means

implies that you are an addict!! It just means you have been on

opiates long enough to have some tolerance. The time this takes

varies significantly from person to person. It may take only 1 week

for a patient to notice he's not getting as good relief with 1

tablet, for example, that he used to. Or the medication may seem like

it's " wearing off " sooner. This can take as long as 6 months to 1

year in other patients. Becomming tolerant sooner than later doen not

mean you are at more risk for addiction either.

ADDICTION is a psychological desire or craving for a drug or

medication; while DEPENDENCE means their is a physiological need for

the medication as an abrupt stopping of the medication will cause

withdrawal. Dependence is a consequence of tolerance and must not be

confused with ADDICTION!

ANYONE WHO IS ON OPIATES FOR A LONG TIME WILL BECOME PHYSICALLY

DEPENDENT! This Only means there will be wthdrawal upon abrupt

stopping of the drug -

Not that there is psychological craving for the drug!!!!

I might soung like I am repeating myself over and over -its because I

am! I really want to hammer this message home because too many people

suffer needlessly because of their erroneous fears of

becomming " addicted. " Sometimes our own MD's help to perpetuate these

fears. The MDs that do this ARE NOT EXPERT in the field of pain

management! If you feel you are not getting your pain management

needs met, request to consult w/ a Pain Management Specialist!

OK! So there's my 2cents worth. I hope this helps. Remember, I'm

always happy to answer questions and receive your email (but I am not

an MD-I just have to say that!) Love to all,

--- In , pauline Gwynne <marypaul40@y...>

wrote:

> Hi everyone

>

> I dont oftenwrite in but I do read all the mails. I take

methotrexate orally but also need an effective antiinflammatory drug

as my joints swell quite badly. A few months ago I was taken off

Vioxx because of the health risks and was given Iberobrufen Retard.

It is not as good as Vioxx was but does help. Now on our local news

they have announced that these can cause cardiac arrest. Im at a

complete loss because my doctor says he doesnt know what else to

prescribe as I have tried a number of meds which didnt suit me. I

must add he is not a very sympathetic man. I wonder if anyone can

make any suggestions about these drugs I would be extremely

grateful. (If you know of any other drug I can use)

>

> Thank you and regards to everyone

>

>

> ---------------------------------

> Messenger NEW - crystal clear PC to PCcalling worldwide with

voicemail

>

>

[Guest guest]

Dear ine and Group:

I'm sure someone has given the " lowdown " on RA medications in the

past. But since you asked, I thought I would tell you a little of

what I know (keeping in mind I'm not an MD); and if others would like

to give their thoughts, please do so. I would also like to pass along

a nice website that people with all kinds of diseases find helpful:

http://www.remedyfind.com

That site is a good place to find out the " anecdotal truth " about

prescribed meds. You'll find out what others thought was helpful or

not.

Anyway here's my lowdown for RA meds:

DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMADs):

These medications should be the very FIRST line of defense because

they can actually slow the erosive course of RA when brought on EARLY

in the disease.The drugs in this catagorie include:

methotrexate (usually 7.5-25mg weekly by mouth or injection)

Gold (25-50mg by injection every 1-4wks OR 3-6mg by mouth daily)

sulfasalazine (2000-3000mg daily)

hydroxychloriquine (200-400mg daily)

penicillamine (250-1000mg daily)

cyclosporin (1.5-2.5mg per kg of your body weight daily)

cyclophosphamine (1-2mg per kg of body weight daily)

leflunomide: this is showing better symptom control than

methotrexate and slows joint corrosion. It also is less

destructive on bone marrow. If you don't get good results

within 4-6wks of starting this med, then it probably isn't

going to work for you. (same as w/methotrexate)

**Kidney and liver function should be monitored w/all of the drugs

in this classification**

BIOLOGICAL RESPONSE MODIFIERS (BRMs):

These medications work by changing the chemical reactions on the cell

surface of very specific cells. These drugs are usually given after

it's determined that the DMARDs are not working. They are generally

quite expensive. Given only by injection, these may be difficult for

some patients to self-administer due to decreased hand strength or

coordination.Drugs in this class include:

etanercept and infliximab

NON-STEROIDAL ANTI-INFLAMMATORIES (NSAIDs):

Both OTC (over the counter) and prescription analgesics that also

decrease inflammation.These drugs do not slow down disease

progression, in fact may even delay early diagnosis of RA, and

therefore delay early start of the DMARDs. These drugs can be used in

conjunction with DMARDs or BRMs -but never should be used by

themselves with the diagnosis of RA since they do not

actually " treat " the disease -only the symptoms!There are many OTC

and RX NSAIDS. Here are just a few:

Ibuprofen

naproxen sodium

** These medications may cause or increase your risk for ulcers

and/or bledding of the GI tract, and kidney impairment because they

are " COX-1 inhibitors. " -1 inhibitors decrease prostoglandins in

the stomach and kidneys. (prostoglandins are one cause of menstrual

cramps-that's why ibuprofen helps so much!) The " -2 inhibitors "

that came in vogue -and went back out again- did not cause a decrease

of prostoglandins, that's why they were easier on the stomach.

Unfortunately, they were hard on the heart!**

CORTICOSTEROIDS:

These medications have strong anti-inflammatory properties, and are

used in the treatment of many diseases where inflammation is a

problem. These " steroids " as they are called has saved many lives

such as in the case of asthma or when there is increased pressure in

the brain from swelling.There are several types of corticosteroids,

but the two major medications used in RA are:

Cortisone- this is injected directly into the affected joints

prednisone/methylprednisolone- this is an oral " steroid " usually

given for short durations in moderate to large doses, then

quickly tapered down. Also given in small doses for indefinite

periods.Often used to minimize disease activity until the DMARD

begins to take effect.

**Long-term use with even low doses of oral steroids can have severe

consequences! Osteoporosis and " avascular necrosis " (which means

literally " without circulation, tissue-death " ) are just a few. It's a

good idea to get a base-line bone density study prior to going on

long-term oral steroids, and then check periodically (every 6 months-

2 years) to make sure there is no bone destruction.**

ANTIBIOTICS:

Interest, and therefore use, of antibiotics wax and wane in the

rheumatalogical field. There have been some studies showing the

medication " minocycline " as a useful therapy in mild RA. To my

knowledge, this drug has not been shown beneficial in severe or

advanced RA.

DRUGS ON THE HORIZON:

Research into the causes of inflammation in RA has caused some

interest in medications that traditionally have been used to treat

other diseases, or in compounds found naturally-occuring in the human

body. Some of these medications or compounds are:

calcitonin (down-regulates monocyte or white blood cell function)

rifampin (a drug used to treat tuberculosis; acts on RNA

synthesis)

retinoid compounds (has multiple effects on biological systems)

anti-tumor necrosis factor (TNF) monoclonal antibodies (delays

abnormal cartilage and bone growth)

OPIOID PAIN MEDICATIONS:

I have included these last because they are not really medications

used in the " management of RA; " although they can be, and generally

are, very useful for " pain management. " :

tramadol -not a true opioid, but a " distant cousin " ; works on the

central nervous system. Like opioids, can develop a

tolerance over time, and there is abuse potential.

hydrocodone -(as in Lortab,Lorcet,Vicodin, Norco, etc)- generally

used for short periods of time, i.e., 1-4 wks or for

" break through " pain when using a long-acting opiate

methadone- often a " first line " or " drug of choice " in long-term

pain management. Tolerance is possible, as with any

opiate, but abuse potential not as high.

oxycodone - (as in Roxicodone, Percocet, Percodan, Tylox, etc.)

Often used for severe pain for short duration or as

" break through " pain med when using a long-acting

opiate such as oxycontin or ms-contin. Tolerance occurs

and potential for abuse high in certain individuals

oxycontin, ms-contin - two different opiates used in long-term

pain management. Tolerance occurs, as with any

opiate,and abuse potential is high in certain

individuals

fentanyl patch - (as in Duragesic patch) An adhesive patch placed

on the skin and replaced every 48-72 hours. Provides

continuous opiate administration

** Obviously the risks of opiate use has to be considered when using

long-term. The " addiction " potential that concerns many chronic pain

patients is real, but not as dramatic as you might imagine. Very few

people who genuinely need pain management become " addicted " to their

medication. It's important to realize that " addiction " is not the

same as " tolerance. " EVERYONE will become tolerant at some point!

This is the nature of opiates. All that means is that it will take

more medication to obtain the same pain relief. This by no means

implies that you are an addict!! It just means you have been on

opiates long enough to have some tolerance. The time this takes

varies significantly from person to person. It may take only 1 week

for a patient to notice he's not getting as good relief with 1

tablet, for example, that he used to. Or the medication may seem like

it's " wearing off " sooner. This can take as long as 6 months to 1

year in other patients. Becomming tolerant sooner than later doen not

mean you are at more risk for addiction either.

ADDICTION is a psychological desire or craving for a drug or

medication; while DEPENDENCE means their is a physiological need for

the medication as an abrupt stopping of the medication will cause

withdrawal. Dependence is a consequence of tolerance and must not be

confused with ADDICTION!

ANYONE WHO IS ON OPIATES FOR A LONG TIME WILL BECOME PHYSICALLY

DEPENDENT! This Only means there will be wthdrawal upon abrupt

stopping of the drug -

Not that there is psychological craving for the drug!!!!

I might soung like I am repeating myself over and over -its because I

am! I really want to hammer this message home because too many people

suffer needlessly because of their erroneous fears of

becomming " addicted. " Sometimes our own MD's help to perpetuate these

fears. The MDs that do this ARE NOT EXPERT in the field of pain

management! If you feel you are not getting your pain management

needs met, request to consult w/ a Pain Management Specialist!

OK! So there's my 2cents worth. I hope this helps. Remember, I'm

always happy to answer questions and receive your email (but I am not

an MD-I just have to say that!) Love to all,

> Hi everyone

>

> I dont oftenwrite in but I do read all the mails. I take

methotrexate orally but also need an effective antiinflammatory drug

as my joints swell quite badly. A few months ago I was taken off

Vioxx because of the health risks and was given Iberobrufen Retard.

It is not as good as Vioxx was but does help. Now on our local news

they have announced that these can cause cardiac arrest. Im at a

complete loss because my doctor says he doesnt know what else to

prescribe as I have tried a number of meds which didnt suit me. I

must add he is not a very sympathetic man. I wonder if anyone can

make any suggestions about these drugs I would be extremely

grateful. (If you know of any other drug I can use)

>

> Thank you and regards to everyone

>

>

> ---------------------------------

> Messenger NEW - crystal clear PC to PCcalling worldwide with

voicemail

>

>