Did you know that...? Ends with a question about backs-RA.

Mat48

Hi - saw a rheumy today for a routine consultation. He wasn't the senior guy who diagnosed me so he just took it as a given that I have RA and has tweaked my meds to get the remaining disease activity down hopefully. So I'm to go up from 15 to 17.5mgs Injectable MTX now. I asked how come the injections have made such a big difference to my ESR which has finally come down from the 60s to 26? He said that injectable MTX is significantly more effective than oral and a dose of 15mg Metoject is equal to 25mg of this drug in tablet form! I was staggered but he was very certain of this.

He also said that lower back pain was not his area as RA doesn't usually cause back problems. It could be wear and tear but he didn't examine me or make any suggestions. Does anyone here definitely have RA in their Sacroilliac joints? Mat x

scattered

Hi Mat,

Lots of people find that injectable MTX works better that tablets. It's because the body can absorb more of the drug when it's given subcutaneously. When meds have to pass through the stomach, their efficacy is diminished due to all the acids in there. That's why some meds have special coatings on them to stop them being absorbed in the stomach. At least that is my understanding of it.

RA in the back is a tough one. A lot of doctors will tell you it never affects the back, which isn't true. RA can, and does, affect any joint in the body, from your knee to the tiny little one in your voice box. My rheumatologist suspects I have RA in my lower back. I haven't had any x-rays or scans that would definitively prove it, but my back stiffness and pain get better when I'm on pred and worse when I'm off it, like the rest of my joints. The rheumatology nurse did say that doing some muscle strengthening exercises might help, so I asked my physio for a couple. They do help- when I do them!

I hope you find some answers an I'm glad you had, what sounds to be a good appointment.

Scat.

Mat48

Well in my case it probably isn't RA Scat but I still think, even if its wear and tear as the physio present at my consultation suggested - it should be examined surely? And the senior consultant said that my diagnosis of RA was for now and "things could change - look out for other symptoms" so what about other types of inflammatory arthritis?

Sorry - of course you can't answer these questions I know but tonight the area where my bum meets the top of my thighs on each side, often a bit sore, is really very painful as well as my lower back -so I'm a little frustrated that the most painful parts of me have been dismissed, whereas the bits that no longer hurt are still showing signs of active RA apparently :roll: Mat x

Ps why haven't you had your back x-rayed yet Scat?

scattered

Of course it should be examined, but sometimes doctors can have tunnel vision and only treat what they have diagnosed, disregarding other things.

I think the reason I haven't had an x-ray or a scan is because there is no point wasting resources to find inflammation when I could see if the drugs will make everything calm down anyway. I'm not overly bothered about having imaging done. The way I see it, I've definitely got joint damage in some joints and knowing about it now isn't going to make it better. Maybe when it gets to the point that the joints need replacing I'll start asking for imaging to be done.

Back pain is rubbish. Do heat or ice help at all? It sounds
like you should go back to your GP and make a bit of a fuss.

Scat.

Mat48

My husband is pointing out that l haven't tried taking anti inflammatories for this - which he takes when he suffers same cramping pain where bum meets thigh and he says this always works for him and be can feel the inflammation go down. I expect you're right about imaging - its all pain and all arthritis so not worth distinguishing until replacements are required. For me I think its probably just one of those things but will discuss pain relief and anti nausea meds with GP in a few weeks time. Mat x

Mumof1

Hi Mat, I have sacroiliitis which affects the sacroilliac joints.

Unless I missed it, you don't mention whether you have had a back or hip xray? As any problem with those joints should show up on the xray.

It may be worth asking/having an xray.

Starburst

Hello Mat,

Nice to see you around here. I'm glad injected MTX is making a difference to your blood tests results, have your symptoms improved too? My rheumy usually drops the MTX dose when moving from tablets to injection form, although I stayed on the same dose. Moving from 20mg tablets to 20mg (0.8ml) in injected form made all the difference to my swelling and stiffness.

You mentioned you don't take anti-inflammatories for the back pain, do you not take them at all then? I'm on the max dose of celebrex and that really helps me. Sorry if you take them and I've misunderstood, I'm still semi-asleep.

Hope you have a lovely weekend.
Sophie x

Mat48

No the rheumy yesterday asked me if I take any other medicine than Hydroxy and MTX and I said I did not. Realised later that this isn't true -I sometimes (often) take Amitriptyline and always take Levothyroxine but I don't take anti inflammatories because I can only stomach them if I also take a stomach protector too now and I rarely take paracetamol either. I hate pills basically and I prefer to put up with pain mostly. But husband says I'm quite inflamed around my lower back and my hip/ thigh is killing me today - am hobbling about like a sad old mare so am going to down an extra strength 'brupofen and an Omaprazole.

Nice to see you too Starburst x

barbara12

Hi Mat
Sorry I cant offer any advice, I have OA..but I am glad to see the meds are working for you, and long may it continue.
Just one thing I have OA in my back mainly the lumber but also a couple of other places, so you get it checked out because physio in the early days is very beneficial.
You take care x

Mat48

Thanks Barbara. I emailed the physio twice but she's not replied yet so will speak to my GP next week to try to get some answers and pain relief. I think it probably is secondary OA because I appear to have that in my fingers too but whether RA makes it worse u just don't know. I've taken some ibruprofen now and done my daily exercises in a very limited lack lustre way. My OH definitely has OA in his hips so the pair if us are turning into 50 year old crocks it seems! X

stickywicket

I've had very mild lower back pain for years and always assumed it was due to all the joints below it being out of kilter. Whether RA or OA I've never investigated. If it's RA the meth should be helping and if it's OA the dullers. I certainly don't want surgery so, for me, it's just a matter of 'put up and shut up'

Mat48

Okay SW I'll shutup about it because I agree with you. Pain is pain and this is the first real pain I've had in ages, very lucky me, and since I'm going up a dose on injectable meth I will hope its RA and that this sorts it out.

Got a big 50th birthday party to hold at the end of March and I do really hope to be able to dance the night away to 70s music so here's hoping that whatever is causing this pain at the centre of my body - it clears off soon because I can barely make it from my bedroom to the loo today let alone in a car or on a dance floor!

On the plus side I've sorted out my medicine drawer so its less of a rummage now. Can anyone remind me whats best re co-codimol - 2 paracetamol 500 plus one codeine 15mg or should it be the other way round? And also does naproxen work well for back pain or should I stick to ibuprofen? If the answer is go ask a pharmacist then I'll try and do that later on! X

tkachev

I always relate my back pain to my hips. When I had a THR in 2009 the back pain went overnight. My other hip is on the way out and find the back pain returns if standing for more than 5 mins. But this is self diagnosis.

Good luck with the 50th party. My 50th is beginning of March but I'm just hoping to spend some time away instead of a party.

Elizabeth

Mat48

Oh you are so sensible Elizabeth! I organised this with friends a while ago as they will be travelling 800 miles to visit us here and didn't want to come for my actual 50th in January. Now I feel besieged by everyone's travel plans and accommodation requirements - had no idea I'd have to be a travel rep too silly me?! X

dreamdaisy

It sounds to me as though your sacro-iliac joints are inflamed: they're the ones that attach your pelvis onto the spine, can you feel them burning away as you sit? Mine hurt all the time, they're sore thanks to my PsA but my back is OK-ish, I get the occasional twinge but that's all.

As for your codeine and paracetamol question I think that's one for your pharmacist. I assume that my combined co-codamols (30/500) contain 30mg codeine and 500mg paracetamol per tablet but I don't know. DD

stickywicket

I really didn't mean that you should 'shut up', Mat, only that it was my own preferred solution. You sound to be in much more pain than I ever have been round there. Mine is just a niggle. Therefore, I don't want anyone tinkering with it :roll: I hope you can find something that helps yours. As for anti-inflamms, I think you should check with the pharmacist as one has to be a bit cautious when using any alongside methotrexate (though it's OK under supervision).

tkachev

Mat48 wrote:

Oh you are so sensible Elizabeth! I organised this with friends a while ago as they will be travelling 800 miles to visit us here and didn't want to come for my actual 50th in January. Now I feel besieged by everyone's travel plans and accommodation requirements - had no idea I'd have to be a travel rep too silly me?! X

They were wise not to want to visit in January! You must have been born right in the middle of that cold, snowy spell in 63. The snow had just gone by time I arrived.

A party would be nice but I thought it woud be too much to organise- as you have found.!But hopefully in the end it will be worth it Mat,

Elizabeth