RA and gastro intestinal issues

FrancesH

Hi Everyone

I'm new to this community, having been recently diagnosed with RA. I'm not on any regular medication to deal with my condition as I'm first having tests to check for other underlying conditions.

I'm interested to know if any other members have experienced problems with acid reflux with RA. My GP says there is no connection but is he right? He admits that his knowledge of RA is limited. He sees it as something that just affects joints but another doctor has said that it is a complex disease that can affect different parts of the body.

I've had one rheumatology appointment (Ninewells, Dundee) when it was confirmed that I had RA and was given a steroid injection. This didn't do much for the problems with my hands but calmed my acid reflux right down. I've spoken to my GP about this and he had no explanation for this as steroids normally aggravate acid reflux.

I look forward to receiving any feedback.

Thanks

Frances

Naomi33

Hello @FrancesH and welcome to the Community.

We are a friendly and supportive group and I hope that will be your experience as well.

I believe you are enquiring about acid reflux after being diagnosed with RA , the following link maybe of use to you.....

https://www.versusarthritis.org/about-arthritis/conditions/rheumatoid-arthritis/

Please keep posting and let us know how you are getting on and I am sure others will connect with you soon.

With best wishes

@Naomi33

Scrummycake

Hi Frances

I have RA and a very sensitive stomach. There is talk about leaky gut causing inflammation/arthritis symptoms, which I suspect I have, but this is different to reflux.

However, having recently been prescribed Meloxicam (strong anti-inflammatory) as I am in the midst of a bad flare, I have noticed acid reflux at nighttime. Have you been taking ibuprofen or similar? I so, could this be causing the reflux and maybe the steroid jab has calmed the inflammation meaning you are taking less tabs? Just a thought.

FrancesH

Hi

Thanks for your comments. The only painkiller tablets I've been taking is paracetamol as I know the likes of ibuprofen can upset the stomach.

I've got another appointment at my local hospital in 3 weeks time and hopefully I'll see someone who will make sense of my symptoms.

Frances

Arthuritis

Dear @FrancesH ,

The great thing is whomever is running tests to eliminate other causes of your symptoms is doing the right thing, it’s called a Differential Diagnosis, essential for correct identification and not making things worse, as often similar symptoms can have different causes, and the wrong treatment makes things worse. I am guessing such a diligent doc doing a DDx must have recently qualified, as all those with more “experience” are often filled with arrogance and jump to conclusions picking a test that confirms their bias, but not anything that would negate their bias.

Your GP that thinks reflux has nothing to do with RA needs to hit the Ned books and read about the Vagus Nerve, and how this powerful nerve controls a lot of things, including heart, stomach acid production and the spleen, signalling these organs to behave differently.

Remind him years ago, ie, before 1981 all GPS insisted that gastric ulcers were caused by a bad lifestyle and stress, and had to take PPIs & Antacids for life. Few could think out of the box when patients reported that treatment for skin infection with antibiotics cured their chronic painful condition, arrogantly and firmly trotting out the same line, antibiotics have no relation to excess stomach acid production. Not one, except Dr Barry Marshall challenged this view, theorising that it was a bacterial infection in the stomach that stimulated the stomach to defend itself with excess acid, hoping to kill the bacteria, but the bacteria were unaffected. Until the antibiotics killed them and the stomach returned to normal.

The gut biome has a profound effect on the human body, including the immune system, so please see the doc they says RA is a complex disease affecting many organs, he seems to still remember what he was taught at med school. Hopefully he is also the one that is doing the differential diagnosis.

My own condition:

I have reflux, which is nasty in its own right, but losing weight keeps it in control.

PPIs + immune suppression is not a good mix, avoid if you can, so hopefully the better GP will be aware of this.

My RA symptoms showed up as very painful feet and later a swollen right index finger. It took a lot of effort to get a diagnosis on the NHS, they kept insisting it was endocrine, then I went private and the private gp said she suspected RA, and referred me to a hospital, where the ACPA & RF blood tests through the roof confirmed it, and the NHS finally accepted my endocrine was fine, it was indeed RA. Going private was very expensive so I would not recommend it, but when in such pain the credit card gets a hammering. Unfortunately I could not afford to get a Differential Diagnosis like you are having, and my RA consultant Professor of Medicine like a tradesman with only a hammer, sees all problems as nails. I strongly suspect it’s a gut & gut biome problem, this thing now called “Leaky Gut”, where past gut damage can trigger immune reactions to your body triggered by bacteria leaking into your bloodstream. I suspect this because one of the downsides of being on immune suppression, in addition to being susceptible to cancer, is you are also prone to bacterial and viral infections. I was given antibiotics for a skin infection, and my RA Symptoms went away after just 2 weeks, that was in March. Here we are in October, with me still trying to convince my RA Prof to refer me to Gastro and look at alternatives.

Go with the GP that is doing the differential and also considers RA to be more complex. It seems one of your GPS needs to learn about the difference between RA and conventional arthritis.

Keep us posted. You are not alone in this fight… where the sick and suffering then have to battle with institutional arrogance and after each fail, will have a spokesperson claiming “Lessons have been learnt”. Nope.

Arthuritis

Forgot to add… @Trish9556 has a special Mylar balloon judge’s gavel that can help treat instances of arrogance and lunacy from powers that be!

FrancesH

Thanks for this.

I'm waiting on an appointment for an endoscopy and I don't think I'll be put on any medication until that is done.

But the waiting is hard especially at times when I feel so poorly and cannot function very well.

Frances

Trish9556

https://community.versusarthritis.org/discussion/comment/714105#Comment_714105

Haha @Arthuritis !

It's getting a lot of use lately!!

Aliball

Hi Frances

I too have RA and after 4 years of trying to get f2f appointment with consultant final get one last week to be told i have had Lupus for past 4 years to, shocker!!!

But to answer your question I have had terrible acid reflux but have had a fab GP at a new practice whom has prescribed Ozermaprozamol. Help greatly. Try the GP again or maybe practice nurse see if they can help. It has made huge difference.

Welsh1

https://community.versusarthritis.org/discussion/61386/ra-and-gastro-intestinal-issues

Hi I am new recently diagnosed with RA had ibs for years and acid reflux that started in last year had lots of antibiotics this year too after not having any for years and covid too.I definitely see a connection and did everything I could diet supplements wise for both. Just been put on medication finding my way round this condition only retired early to have this diagnosis. My problem is i need painkillers as tried exercise etc toe very painful so have to take acid meds. I have Raynauds too I hope this will settle dealing with pain and raynauds difficult. I am sure I will be using this site a lot. Not sure if any supplements help RA? trying diet. Wish you well.

noddingtonpete

Hello @Welsh1 and welcome to our friendly and supportive community. Good to have you here.

I see you are looking at diet and supplements and whether they help with RA - have a look at the following from our website, hope it might be of some use.

https://www.versusarthritis.org/about-arthritis/complementary-and-alternative-treatments/types-of-complementary-treatments/diet-and-nutritional-supplements/

Please keep posting now you you are here and let us know how you are getting on.

With best wishes

Peter

Arthuritis

@Aliball Did you mean Omeprazole for your reflux? If you are on a PPI your gp and rheumy might need to be aware and adjust your methotrexate (MTX) dose if you are on the high end like I was, or swap your PPI for something else.

According to NIH

“There is evidence to suggest that concomitant use of methotrexate (primarily at high doses) with PPIs such as omeprazole, esomeprazole, and pantoprazole may decrease methotrexate clearance, leading to elevated serum levels of methotrexate and/or its metabolite hydroxymethotrexate, possibly leading to methotrexate toxicities. In several case reports, no methotrexate toxicity was found when a histamine H2 blocker was substituted for a PPI. Based on the reviewed data, the FDA updated the methotrexate label to include the possible drug–drug interaction between high-dose methotrexate and PPIs. Physicians should be alerted to this potential drug–drug interaction in patients receiving concomitant high-dose methotrexate and PPIs.”

Most NHS docs seldom keep up with research findings in their field, (too busy/too tired/too arrogant) relying on NICE & NHS internal bulletins which usually only cover a tiny fraction of situations often as a result of something that has gone to court and the NHS spokesperson has said something that includes “lessons will be learnt from this”. Unfortunately you have to be your own advocate and double check everything.

I was even prescribed penicillin antibiotics while on the max MTX dose, which made me horribly sick, for the same reasons as above, many drugs interact with MTX.

It is contraindicated in the NICE drug bible, the British National Formulary (BNF) but few GPs except newly qualified ones refer to it carefully for interactions, relying on dosage knowledge only as it’s easy to remember and as they have personally not had an adverse reaction on their hands that landed them in the dock, it’s one more check that’s not done. When asked, the response is often “I don’t need to check it, I have been prescribing it for years. I have never heard of a contraindication” OK, humour me and check. After some reluctant checking.. “Oh I see, never noticed it before, must be new/too busy/sorry”The worst part is this is something that the NHS drug prescription system could easily automate and do a more reliable job checking before releasing a prescription to the pharmacy than any fallible human GP, but it’s not done in the UK because it’s not a prestigious career boosting project, such as those with a huge budget eg like National Program for IT (NPfIT) in the National Health Service (NHS)  where billions were written off after abject failure. The same goes for why there’s no universal booking system for patients to book appointments at a GP or hospital, when private enterprise such as clinics hospitals and hotels restaurants airlines have had this for decades, nobody wants to touch a boring project.

The point being that the NHS is far from perfect, most people have a rose tinted view of the NHS, until they encounter it. The lucky few have a great experience, and are grateful for a service very expensively delivered due to its inefficiency, but grateful it’s there at all. However a great number of patients are far less lucky and assume they have to accept their fate. In such a system your health outcomes can vary greatly depending on how much support you have or an advocate for your own treatment…

Gadgetgirl

Hi there. I have RA and went on MTX and steroids along with Naproxen. I had really bad acid reflux to the point it made the RA pain seem ok. I came off the steroids and yet still suffered. I was on different PPI to try and control the reflux. I moved from MTX tablets to injection but still had the refulx. It was so bad my dentist actually mentioned if the RA was under control as he could see my back teeth were being corroded by the refulx. I did lots of research and found that PPI are bad for you as they get rid of the stomach acid, something we need to aid digestion. I even saw a Gastroenterologist who at least confirmed I had no internal damage and my spinchter was working ok. I stopped the PPI’s and started to take Apple Cider vinegar every day and this really started to help. Also RA is not just your joints unfortunately , it’s an inflammatory disease which means as well as joints other organs can be effected. Something else you can explore, is if depending on your age, perimenopause could have started which causes joint pain, inflammation, and yes you guess it acid reflux. Apparently when hormone levels drop the esophageal sphincter muscle relaxes, thus allowing acid to come back up. I’ve done so much research on this as I was suffering for months on end with no real answer. I strongly believe now that when I get the refulx it is hormonal and linked to my cycle and this is also when I normally get a flare. Hope you get some answers and the right treatment. Good luck