Re: advice on next level of drugs

[Guest guest]

I take 5 mg of prednisone in the morning and the same at night. I've been taking that dose since May '04. I gained 25 lbs in the first 3 months. I haven't gained anymore and I resently lost 15 - 20 in the last 3 months. It's harder to lose when on prednisone but it can be done. I'm still quite overweight but I'm working on it. Helen P. Tana Albin <talbin2@...> wrote: Hi, I have a moderate rheumatoid

arthritis that seems to be getting worse. I have been able to just take plaquenil, relafen and low doses of prednisone along with a kenolog shot every three months for several years now. Unfortunately, the shots are not doing it for me anymore and I am more reliant on the prednisone, which I am under the impression my Rheumatologist would rather I not depend on so much. My question is, what do you think is my next line of defense in the drugs? What should I request from the doc if I get my choice? Of course, like everyone, I would rather have the least side effects and the least potency to still do the trick, but keep me as well as possible. Prednisone does work very well for me, but I am already over weight and have a strong family

history of diabetes, so this may be why my doc would prefer I don't rely on it too much, I don't know. Do many of you take prednisone daily? Maybe this is all I need. I am really afraid of one thing, and that is the cancer risk that some of these drugs tote. Can anyone help talk me through this? I am going to see the doctor this week and I want to advocate for myself. I am 43. Thanks, Tana

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[Guest guest]

In addition to weight gain, mood swings

and diabetes another side effect of corticosteroids like Prednisone and Kenolog

is that they lead to bone loss unless you take a medicine like Fosamax along

with calcium and vitamin D to counteract it.

The next drug is likely to be Methotrexate

or it could be Sulfasalazine. Methotrexate is the stronger and more

common medication but for some people Sulfasalazine has fewer side effects.

Most of the side effects of Methotrexate are nausea and mouth sores but these

are usually reduced by using injections instead of pills. A less common

side effect is liver damage but that is reversible if treated early. That’s

why we have blood tests every couple of months.

The newest, most expensive, and usually

most effective drugs are the biologics (Humira, Enbrel, and Remicade are most

common, Kinaret is a bit older but usually less effective, and both Orencia and

Rituxan are the newest ones). Your insurance probably won’t pay for

a biologic until you show that Methotrexate fails you. Some early work

showed and increase in lymphomas with some of the biologics but more recent

work with larger samples does not show any increased risk of cancer by taking

the biologics.

I used Prednisone for about a year and a

half but haven’t used it for about the last two years. I hope this

gives you at least partial answers to all of your questions. Ask more

questions if you have any. God bless.

From: Rheumatoid Arthritis [mailto:Rheumatoid Arthritis ] On Behalf Of Tana Albin

Sent: Friday, September 15, 2006

8:07 PM

Rheumatoid Arthritis

Subject:

advice on next level of drugs

Hi, I have a moderate rheumatoid arthritis

that seems to be getting worse. I have been able to just take plaquenil,

relafen and low doses of prednisone along with a kenolog shot every three

months for several years now. Unfortunately, the shots are not doing it

for me anymore and I am more reliant on the prednisone, which I am under

the impression my Rheumatologist would rather I not depend on so much.

My question is, what do you think is my

next line of defense in the drugs? What should I request from the doc if I get

my choice? Of course, like everyone, I would rather have the least side effects

and the least potency to still do the trick, but keep me as well as possible.

Prednisone does work very well for me, but

I am already over weight and have a strong family history of diabetes, so this

may be why my doc would prefer I don't rely on it too much, I don't know.

Do many of you take prednisone daily?

Maybe this is all I need. I am really afraid of one thing, and that is the

cancer risk that some of these drugs tote. Can anyone help talk me through

this?

I am going to see the doctor this week and

I want to advocate for myself.

I am 43. Thanks, Tana

.._,___

[Guest guest]

Dear Tana- Taking Prednisone as a maintenance dose of under 10m. I am on 7mg (6)am )1)pm. I take mtx once a week and have been on remicade since 2000. I do have an option for you. Ask your doctor about trying cyclosporine. It works when taken with MTX. I took it since 1995 and it worked great for five years. its actually a soil fungus that helps against transplant rejection but is used in many other instances. Prednisone is a leading cause of osteoporosis and if you are overweight, then finding a good medication to take over and reduce your prednisone will help you lose weight. Ask your doctor about a bone density test if you havent already. Remember that managing RA isnt the same as stopping the damage. I didnt have any deformity being on cyclosporine. Although it doesnt work for everyone, it couldnt hurt to get more info. A biologic seems to be the trend. Also have your thyroid checked. That can be affected over time with RA and taking steriod also. Good luck. Deborah

On 9/16/06, Tana Albin <talbin2@...> wrote:

Hi, I have a moderate rheumatoid arthritis that seems to be getting worse. I have been able to just take plaquenil, relafen and low doses of prednisone along with a kenolog shot every three months for several years now. Unfortunately, the shots are not doing it for me anymore and I am more reliant on the prednisone, which I am under the impression my Rheumatologist would rather I not depend on so much.

My question is, what do you think is my next line of defense in the drugs? What should I request from the doc if I get my choice? Of course, like everyone, I would rather have the least side effects and the least potency to still do the trick, but keep me as well as possible.

Prednisone does work very well for me, but I am already over weight and have a strong family history of diabetes, so this may be why my doc would prefer I don't rely on it too much, I don't know.

Do many of you take prednisone daily? Maybe this is all I need. I am really afraid of one thing, and that is the cancer risk that some of these drugs tote. Can anyone help talk me through this?

I am going to see the doctor this week and I want to advocate for myself.

I am 43. Thanks, Tana

-----Original Message-----From: Rheumatoid Arthritis [mailto:

Rheumatoid Arthritis ] On Behalf Of HertlingSent: Friday, September 15, 2006 5:00 PM

Rheumatoid Arthritis Subject: Re: methotrexate side effects

Wow I have no experience to share with you (andhopefully wont, sorry!) I've been off and onMethotrexate for a while, its done a decent job sofar. I just wanted to write to say Im so sorry you are

going through so much. Youre in my thoughts andprayers.--- podunkescape <podunkescape@...

> wrote:> hi> must be quick bc hard to sit long. have had a> series of bad > infections,, liver and pancreatic activity since i> used mtx in l994. > has anyone else had similar prblems? i'm very, very

> weak, too. drs are > mystified. chris> > > > > > >

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[Guest guest]

Tana,

Prednisone has significant bad effects when used long-term and

doesn't slow or halt the disease like a disease modifying anti-

rheumatic drug such as the plaquenil you are already on. Best to get

off it ASAP! If you are needing something stronger, my guess is that

most rheumatologists would suggest methotrexate. I was on it for two

years and I found it very helpful.

Sierra

>

> Tana Albin <talbin2@...>

wrote:

> Hi, I have a moderate rheumatoid arthritis that seems to be

getting worse. I have been able to just take plaquenil, relafen and

low doses of prednisone along with a kenolog shot every three

months for several years now. Unfortunately, the shots are not

doing it for me anymore and I am more reliant on the prednisone,

which I am under the impression my Rheumatologist would rather I

not depend on so much.

> My question is, what do you think is my next line of defense in

the drugs? What should I request from the doc if I get my choice?

Of course, like everyone, I would rather have the least side

effects and the least potency to still do the trick, but keep me as

well as possible.

> Prednisone does work very well for me, but I am already over

weight and have a strong family history of diabetes, so this may be

why my doc would prefer I don't rely on it too much, I don't know.

> Do many of you take prednisone daily? Maybe this is all I need.

I am really afraid of one thing, and that is the cancer risk that

some of these drugs tote. Can anyone help talk me through this?

> I am going to see the doctor this week and I want to advocate

for myself.

> I am 43. Thanks, Tana

>

>

>

>

>

>

>

>

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

> Messenger with Voice. Make PC-to-Phone Calls to the US (and

30+ countries) for 2¢/min or less.

>

[Guest guest]

Some early work showed and increase in

> lymphomas with some of the biologics but more recent work with larger

> samples does not show any increased risk of cancer by taking the

biologics.

Harold,

I believe you are incorrect. A recent study that splashed the news (6

months ago?)identifed very significant risks for both lymphoma and

serious infections with the use of Humira and Remicade. (Enbrel was not

included in the study as it has a slightly different make up.)

Sierra

[Guest guest]

http://www.eurekalert.org/pub_releases/2006-08/jws-tnf082406.php

Please check the above for later and

larger studies. The observed difference according to the earlier study was

large in the relative sense (perhaps threefold) but it was small in the

absolute sense (perhaps 3 in 10,000 instead of 1 in 10,000) but I didn’t

look up the actual numbers. God bless.

From: Rheumatoid Arthritis [mailto:Rheumatoid Arthritis ] On Behalf Of snowdrift52003

Sent: Saturday, September 16, 2006

5:36 PM

Rheumatoid Arthritis

Subject:

Re: advice on next level of drugs

Some early work showed and increase in

> lymphomas with some of the biologics but more recent work with larger

> samples does not show any increased risk of cancer by taking the

biologics.

Harold,

I believe you are incorrect. A recent study that splashed the news (6

months ago?)identifed very significant risks for both lymphoma and

serious infections with the use of Humira and Remicade. (Enbrel was not

included in the study as it has a slightly different make up.)

Sierra

[Guest guest]

Hi Tana, This is Steph in VA. I'm 29 and was dx'd with RA when I was 22. I was on prednisone at high doses in the beginning. I was a size 6 pre-RA. After high doses of prednisone I grew to a size 18. Now I'm on 2 mg/day & I'm a size 12. About 4 weeks after I was dx'd I began methotrexate. I have been fortunate not to have any side effects on my meds. 6 months after I was dx'd I began Enbrel. I switched to Remicade in March 2000 & I'm still on it 6 years later. My father has diabetes as well so my rheumy is concerned about the prednisone. However, he also doesn't let me change meds during stressful times. Sadly, the past 6 years have been weaved with much loss -- death of loved ones (including my godfather & my beloved rheumy) -- and much happy stress, like my recent wedding in May. Despite my prednisone use & severe RA, I have had

near-perfect bone density scans, showing only minor erosion. My rheumy says that TNF also accelerates bone erosion so when a TNF inhibitor works well it halts/slows erosion of the bones. I'm rambling as usual. Take care, Steph in VA Tana Albin <talbin2@...> wrote: Hi, I have a moderate rheumatoid arthritis that seems to be getting worse. I have been able to just take

plaquenil, relafen and low doses of prednisone along with a kenolog shot every three months for several years now. Unfortunately, the shots are not doing it for me anymore and I am more reliant on the prednisone, which I am under the impression my Rheumatologist would rather I not depend on so much. My question is, what do you think is my next line of defense in the drugs? What should I request from the doc if I get my choice? Of course, like everyone, I would rather have the least side effects and the least potency to still do the trick, but keep me as well as possible. Prednisone does work very well for me, but I am already over weight and have a strong family history of diabetes, so this may be why my doc would prefer I don't rely on it too much, I don't

know. Do many of you take prednisone daily? Maybe this is all I need. I am really afraid of one thing, and that is the cancer risk that some of these drugs tote. Can anyone help talk me through this? I am going to see the doctor this week and I want to advocate for myself. I am 43. Thanks, Tana -----Original Message-----From: Rheumatoid Arthritis [mailto:Rheumatoid Arthritis ] On Behalf Of HertlingSent: Friday, September 15, 2006 5:00 PMTo:

Rheumatoid Arthritis Subject: Re: methotrexate side effects Wow I have no experience to share with you (andhopefully wont, sorry!) I've been off and onMethotrexate for a while, its done a decent job sofar. I just wanted to write to say Im so sorry you aregoing through so much. Youre in my thoughts andprayers.--- podunkescape <podunkescape > wrote:> hi> must be quick bc hard to sit long. have had a> series of bad > infections,, liver and pancreatic activity since i> used mtx in l994. > has anyone else had similar prblems? i'm very, very> weak, too. drs are > mystified. chris> > > > > > > --No virus found in this incoming message.Checked by AVG Free Edition.Version: 7.1.405 / Virus Database: 268.12.4/449 - Release Date: 9/15/2006 --No virus found in this outgoing message.Checked by AVG Free Edition.Version: 7.1.405 / Virus Database: 268.12.4/449 - Release Date: 9/15/2006

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[Guest guest]

Thank you all for your comments. I knew you wouldn't let me down!

-----Original Message-----From: Rheumatoid Arthritis [mailto:Rheumatoid Arthritis ] On Behalf Of Tana AlbinSent: Friday, September 15, 2006 10:07 PMRheumatoid Arthritis Subject: advice on next level of drugs

Hi, I have a moderate rheumatoid arthritis that seems to be getting worse. I have been able to just take plaquenil, relafen and low doses of prednisone along with a kenolog shot every three months for several years now. Unfortunately, the shots are not doing it for me anymore and I am more reliant on the prednisone, which I am under the impression my Rheumatologist would rather I not depend on so much.

My question is, what do you think is my next line of defense in the drugs? What should I request from the doc if I get my choice? Of course, like everyone, I would rather have the least side effects and the least potency to still do the trick, but keep me as well as possible.

Prednisone does work very well for me, but I am already over weight and have a strong family history of diabetes, so this may be why my doc would prefer I don't rely on it too much, I don't know.

Do many of you take prednisone daily? Maybe this is all I need. I am really afraid of one thing, and that is the cancer risk that some of these drugs tote. Can anyone help talk me through this?

I am going to see the doctor this week and I want to advocate for myself.

I am 43. Thanks, Tana

-----Original Message-----From: Rheumatoid Arthritis [mailto:Rheumatoid Arthritis ] On Behalf Of HertlingSent: Friday, September 15, 2006 5:00 PMRheumatoid Arthritis Subject: Re: methotrexate side effects

Wow I have no experience to share with you (andhopefully wont, sorry!) I've been off and onMethotrexate for a while, its done a decent job sofar. I just wanted to write to say Im so sorry you aregoing through so much. Youre in my thoughts andprayers.--- podunkescape <podunkescape > wrote:> hi> must be quick bc hard to sit long. have had a> series of bad > infections,, liver and pancreatic activity since i> used mtx in l994. > has anyone else had similar prblems? i'm very, very> weak, too. drs are > mystified. chris> > > > > > >

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