How To Cope With Side Effects Of Methotrexate
What to do about:
- loss of appetite, feeling or being sick, stomach ache or indigestion eat simple meals and do not eat rich or spicy food. It can help to eat and drink slowly and have smaller, more frequent meals. If you’re being sick, try taking small, frequent sips of water to avoid dehydration. For stomach ache, putting a heat pad or covered hot water bottle on your stomach may help.
- diarrhoea drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
- headaches, feeling tired or drowsy rest and drink plenty of water. Do not take non-steroidal anti-inflammatories, such as ibuprofen. You can try a painkiller such as paracetamol. Do not drink too much alcohol. Do not drive, cycle or use machinery if you feel tired or drowsy. Speak to your doctor if this does not get better.
- hair loss this is unlikely to be permanent. If hair loss bothers you, talk to your doctor. They may be able to lower your dose or recommend a different medicine.
Methotrexate Is A Popular Dmard Used To Treat Ra
The most frequently used DMARD for RA is Trexall , which takes up to six weeks to start working, with the full effect not seen until after 12 weeks of treatment. Up to 90 percent of people with RA take methotrexate at some point during treatment, according to the Arthritis Foundation.
About 20 percent of patients eventually stop taking methotrexate due to its side effects, which include upset stomach, sore mouth, muscle aches, and hair thinning due to a drop in folic acid levels from the drug. Patients are often given folic acid supplements to reduce these side effects.
Your doctor may prescribe other DMARDs along with methotrexate, including:
These drugs may cause various other side effects, such as rash, abdominal pain, and vision and eye problems.
Is Methotrexate Safe If Im Pregnant Or Planning To Be
Methotrexate can cause birth defects. It can also increase the risk of infertility in men who take it. If you arent taking methotrexate yet and are planning to be pregnant, let your doctor know. They will likely recommend that you hold off on starting methotrexate. However, if you are already taking it, you may be asked to stop and wait 1 to 3 months before trying to conceive.
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What Are Effective Over
Most patients with Rheumatoid Arthritis will, at some point, use over-the-counter medications to control pain — most commonly, acetaminophen . Other OTC medications which can help with RA pain and inflammation include aspirin and non-prescription versions of ibuprofen or naproxen . In addition, some topical pain medications may also provide relief. These ointments and creams are generally divided into three categories:
Salicylates
Salicylates are derivatives of aspirin. In topical form, they are absorbed through the skin and exert a local, anti-inflammatory effect.
- Aspercreme
- Omega-3-fatty acids, found in fish oil capsules, may reduce inflammation.
- The same would be true for gamma-linoleic acid. Herbal preparations with possible benefits include ginger, Devil’s claw, and white willow.
What Otc And Prescription Drugs Treat Spinal Osteoarthritis
Over-the-counter and prescription medications for spinal arthritis are usually the same as those taken to treat joint-related arthritic pain in the hips and kneesunless the diagnosis is rheumatoid or another type of inflammatory arthritis. For patients with symptoms of pain or numbness affecting the arms or legs, a may be considered.
Today, people with spinal arthritis have access to different types of pain medications that can be taken or applied to relieve pain. Some require a doctor’s prescription, some do not. However, do not assume that just because a drug is available without a prescription, or over the counter, that it is safe for everyone.
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Spinal Cord Stimulation: An Alternative Or Adjunct To Medication For Spinal Osteoarthritis
If youve taken several medications for your spinal osteoarthritis with little relief, your doctor may recommend , also known as neuromodulation to help relieve your chronic back or neck pain.
Spinal cord stimulation generates mild electrical impulses that block pain signals from reaching your brain. Pain is perceived in the brain. Neuromodulation involves implanting a small generator either in your abdominal or buttock area and thin wires called leads into the spinal canal. Some patients are not candidates for SCS, such as people who are pregnant, have a heart condition, epilepsy or have an existing implanted device such as a pacemaker. If your doctor recommends SCS, the first step is a trial period where the system is temporarily worn outside your body. If your pain improves using the stimulator, the device may be implanted surgically.
For some patients, spinal cord stimulation also helps them reduce their dependence on opioids or other pain medications. If youre concerned about tapering or weaning off your pain medication, talk to your doctor about strategies that may ease this process.
Rare But Serious Side Effects Of Nsaids
In rare instances, NSAIDs can damage your liver and kidneys. The higher the dosage and the longer the treatment, the higher the risk. If you have liver or kidney problems, you may not be able to take NSAIDs.
An allergic reaction to these drugs is also possible, but not common. A reaction is serious if you experience:
- wheezing
- swelling of your face or throat
- difficulty breathing
If you have any of these symptoms while taking an NSAID, contact your doctor right away. If you think that any of these symptoms are life-threatening, call 911.
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What Is Arthritis Pain Like
Arthritis typically causes joints to become painful, stiff, and sometimes swollen. But these arent the only symptoms that someone with arthritis might feel. Arthritis can also cause joints to feel constantly achy, and many people with arthritis report muscle weakness, muscle aching, and feelings of tiredness.
Which Biologic Drugs Are Self
TNF-blockers Enbrel , Humira , Simponi , and Cimzia are all administered by subcutaneous self-injection. Kineret , a biologic drug that inhibits the action of interleukin-1, is also given by subcutaneous self-injection.
TNF blocker Remicade , as well as Rituxan which targets CD20-positive B-cells, T-cell co-stimulation modulator Orencia , and Actemra which blocks IL-6 are not given by self-injection. Instead, they are administered by intravenous infusion.
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How Can Side Effects Be Avoided
NSAIDs should only be used when needed, and not over a long period of time in other words, only to relieve acute pain. It’s important to use the lowest dose possible, and not to exceed the maximum daily dose. If you’re considering using NSAIDs, it’s best to talk to your doctor about the most suitable medication and dose.
The risk of complications affecting the gastrointestinal tract can be lowered considerably by taking NSAIDs together with medicine designed to protect the lining of the stomach. These include, in particular, proton pump inhibitors like omeprazole or pantoprazole.
Alternatively, diclofenac or ibuprofen can be applied to the painful joint in the form of a cream or gel. The risk of side effects is then much lower than it is if you take tablets.
Starting And Raising A Family
If you’re taking medicines for rheumatoid arthritis, let your healthcare team know if you want to start a family or you’re worried about becoming pregnant while taking medicine.
Some medicines, such as methotrexate, leflunomide and biological treatments should not be taken by men or women while they’re trying for a baby.
Your heathcare team will work with you to try to keep your rheumatoid arthritis under control while you’re trying to get pregnant.
Babies and young children are physically and mentally demanding for any parent, but particularly if you have rheumatoid arthritis.
If you’re struggling to cope, it may help to talk to other people in the same situation as you.
You may also be able to get extra support from your health visitor or occupational therapist to help you manage your young family.
Further information
Pain, discomfort and changes in the way you feel can affect your sex life.
Your self-esteem or thoughts about how you look may affect your confidence.
Although many people find it difficult to talk about such private issues, there are resources that may help you.
Talking to your partner or GP about the impact of rheumatoid arthritis on your sexuality and sexual relationships may help.
Further information
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How Does Methotrexate Work To Treat Rheumatoid Arthritis
Methotrexate belongs to a group of medications known as nonbiologic DMARDs . Examples of other nonbiologic DMARDs used to treat RA include , , and .
We dont know exactly how methotrexate works to treat RA yet, but researchers agree that it has an effect on the immune system. Methotrexate is thought to prevent your body from mounting immune and inflammatory responses. One way researchers think it does this is by blocking the effects of folic acid, a chemical that supports the production of new cells. Methotrexate may also ramp up processes in your body that counteract inflammation.
What Are The Pros And Cons Of Non
NSAID painkillers can relieve pain in the joints. Examples of these drugs include:
- celecoxib
Research has found that they relieve symptoms in about 15 out of 100 people.
The possible side effects of anti-inflammatory painkillers include:
- An upset stomach: in about 3 out of 100 people.
- Ulcers and bleeding in the stomach: in up to 2 out of 100 people who take NSAIDs for a year.
- Cardiovascular disease: in up to 1 out of 100 people who take NSAIDs for a year.
The risk of side effects and complications will depend on various factors, such as the exact medication and dose used. Celecoxib and etoricoxib are less likely to cause stomach problems than other NSAIDs are.
With the exception of acetylsalicylic acid , NSAIDs can somewhat increase the risk of cardiovascular diseases such as heart attacks. This risk is lowest when using naproxen, so naproxen is the most suitable NSAID for people who have both rheumatoid arthritis and a cardiovascular disease.
When used over the long term, NSAIDs can lead to stomach ulcers. These are usually felt as a pain in the upper abdomen. The pain is particularly noticeable just after eating, when the stomach produces more acid. Sometimes stomach ulcers don’t cause any symptoms, and people only find out that they have one if they have serious complications such as bleeding in the stomach.
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What Are The Symptoms Of Rheumatoid Arthritis
The main symptoms of RA are joint pain, swelling, and stiffness. Usually, symptoms develop gradually over several weeks, but in some people, symptoms develop rapidly.
The small joints of the hand and feet are usually the first to become affected. Stiffness is usually worse first thing in the morning or after periods of inactivity and may make movement difficult. RA usually affects the joints on both sides of the body equally.
The pain is typically described as throbbing and aching. Joint stiffness is usually worse in the morning but still tends to persist, unlike stiffness caused by osteoarthritis which tends to wear off after about 30 minutes. Because the tissue inside the joints is affected, joints may look swollen and feel hot and tender to the touch. Some people develop firm swellings under the skin, called nodules, around affected joints.Joint and bone destruction can occur over time if the disease process is not well-controlled.
Patients may also lack energy and have experience fevers, sweating, a poor appetite, and weight loss. Other symptoms may occur depending on what other parts of the body are affected, for example, dry eyes, or heart or lung problems.
Types Of Medication That Treat Rheumatoid Arthritis
SeeRheumatologist’s Role in Patient Care
When prescribing a medication, a physician will take into account the patients age, disease activity, and other medical conditions, but each patient is unique. Figuring out which medication or combination of medications work best for an individual can be challenging and often requires a process of trial and error.
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Who Can And Cannot Take Methotrexate
Methotrexate can be used by adults and children.
Methotrexate is not suitable for some people.Tell your doctor before taking methotrexate if you:
- have ever had an allergic reaction to methotrexate or any other medicine
- are pregnant, trying to get pregnant or are breastfeeding
- have severe liver, kidney, or blood disease
- have an infection
- have mouth ulcers, or have been diagnosed with a stomach ulcer or duodenal ulcer
- are due to have a “live” vaccine
Orthotic Inserts And Braces
Some people find that wearing an orthotic insert, which fits into the shoe, or a foot or ankle brace helps to ease arthritis symptoms. By limiting the movement of the foot or ankle joint, an insert or brace may relieve pain and stiffness, making it more comfortable to walk.
Orthotic inserts are available in different sizes and levels of stiffness. They can be placed in the shoe to support different parts of the feet, depending on the location of your arthritis pain. Orthotic inserts help reduce the amount of stress put on arthritic areas of the foot by redistributing the weight of the body to other parts of the foot, providing pain relief.
Braces also come in different sizes and levels of support. Some are flexible and worn in addition to regular shoes, and others resemble a cast that covers part of the foot and ankle. NYU Langone doctors can advise you on the type of brace that best suits your lifestyle and the severity of your symptoms. If youre planning to spend the day in an environment that requires very little walking, for instance, a light brace may be all you need. If your job requires you to be on your feet all day, a brace with more support might be a better choice.
Some of the time, inserts and braces available at drugstores work well. If your doctor suggests that a brace or orthotic insert designed to fit the shape of your foot may be more effective, NYU Langone specialists can customize a brace or orthotic insert to ensure it provides the support you need.
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Arthritis And Heart Disease
Learn how having arthritis can affect heart health and what you can do to protect yourself.
Youre probably all too aware of how arthritis affects your joints. But having arthritis osteoarthritis , but especially inflammatory conditions like rheumatoid arthritis , gout, lupus and psoriatic arthritis also puts you at increased risk for heart disease. That includes heart attack, stroke, atrial fibrillation , high blood pressure, heart failure, and atherosclerosis .
Those with gout are also at greater risk for a heart attack or of dying from cardiovascular and coronary heart disease. Gout was linked to a 15% higher risk for heart attack, stroke, or death from heart disease in a 2018 study published in the Journal of the American Heart Association.
People with OA face a 24% higher risk for cardiovascular disease, according to a meta-analysis of 15 studies that included nearly 360,000 people. The authors say shared heart disease risk factors such as high cholesterol and diabetes, along with inactivity and the use of nonsteroidal anti-inflammatory drugs , may be behind the increased risk. Another important contributor to heart disease is inflammation that can come with OA.
Chronic Inflammation and Your Heart
Inflammatory cells get into blood vessel walls where they make cytokines immune system proteins that promote inflammation. Inflammation also reshapes blood-vessel walls, making deposited plaques more prone to rupture. A rupture, in turn, can trigger a heart attack.
Can Diet Help Treat Arthritis
Research suggests that following an anti-inflammatory diet can reduce osteoarthritis and rheumatoid arthritis symptoms. A healthy diet can also lead to weight loss, which reduces stress and strain on joints. Gout, a form of metabolic arthritis, can be relieved by avoiding purines that can trigger gout flares.
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Is It Safe To Take Tylenol Daily For Arthritis Pain
Question: I suffer from osteoarthritis. My doctor says I should keep exercising even though my joints hurt. He says its okay for me to take a pain medication like Tylenol in order to remain active. But Ive read that Tylenol can damage my liver. What am I to do?
Answer: You are right to be concerned about medication safety. But your doctors also right that you need to be physically active. So how do you balance these seemingly competing objectives?
I posed your question to two specialists at Sunnybrook Health Sciences Centre: One is a surgeon who performs joint replacement operations and the other is an expert in drug safety.
Lets start with the surgeon. Dr. Jeffery Gollish, Medical Director of Sunnybrooks Holland Orthopaedic and Arthritic Centre, says he sees lots of people who feel the same way you do.
Many patients, he says, fear that exercise will lead to additional damage of their joints. The fact that it hurts when they move is taken as a sign that they are doing harm to themselves. And they worry medications that mask their pain will simply allow them to do even more harm.
The issues of exercise and medication are two areas where the public has misconceptions, says Dr. Gollish. They think both are harmful. In fact, both are beneficial.
Exercise, in general, is good and wont harm the joints. The only thing we tell people to stop doing is running and avoiding any impact activity.
An extra-strength tablet contains 500 milligrams.
Tumor Necrosis Factor Inhibitors
Tumor necrosis factor alpha is a pro-inflammatory cytokine produced by macrophages and lymphocytes. It is found in large quantities in the rheumatoid joint and is produced locally in the joint by synovial macrophages and lymphocytes infiltrating the joint synovium. TNF is one of the critical cytokines that mediate joint damage and destruction due to its activities on many cells in the joint as well as effects on other organs and body systems. TNF antagonists were the first of the biological DMARDS to be approved for the treatment of RA. These drugs began to enter the market for rheumatoid arthritis in 1999 and are now considered a part the ACR recommendations for treatment of RA. There are currently five TNF inhibitors FDA approved for the treatment of RA etanercept , infliximab , adalimumab , certolizumab pegol , and golimumab . Etanercept is a soluble TNF receptor-Fc immunoglobulin fusion construct infliximab, adalimumab, and golimumab are monoclonal antibodies and certolizumab pegol is an anti-TNF antigen binding domain-polyethylene glycol construct. While differing in structure, the efficacy and safety of the drugs is similar across the class in reducing the signs and symptoms of RA, as well as in slowing or halting radiographic damage, when used either as monotherapy or in combination with methotrexate.
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