Arthritis in the UK

[definenredefine]

Hi, I should have mentioned why I biased to that much caution.. I had hepatitis C when I was 18, and while my immune system cleared the virus within weeks, antibodies remain. Doctors so often told me that this meant there wasn't any certainty that some remaining virus might not remain somewhere, and also warned that I may have some liver trouble after a few decades even if it had been entirely cleared early. Given that so many other things can cause cirrhosis or fatty liver deposits, I decided to be cautious in dosing, far more so than the guidance on the packet. If we can get by with less, I think it's worth doing on general principle. Not that I'm advocating homoeopathy here.

That is totally fair, and I definitely should have added existing liver disease as a caveat. My mistake (and a particularly not great one to make as a pharmacist. D'oh.)

But topicals are not without risk, and gastrointestinal bleeding has been observed in users of topicals, albeit at a much lower frequency compared to oral NSAIDs when used daily.

Interesting. I guess there must be a fair amount of systemic absorption with the topicals.

 

[red_rhino]

I’m doing some follow up evaluation for osteoarthritis in my right pinky finger tomorrow.

So yeah, X-ray shows the cartilage in the last joint of my right pinky is gone. There’s a nice bone spur developing there.

What's your opinion on topical NSAIDs, eg diclofenac, for osteoarthritis? Should they only be used for muscular pain?

But topicals are not without risk, and gastrointestinal bleeding has been observed in users of topicals, albeit at a much lower frequency compared to oral NSAIDs when used daily.

Doctor prescribed diclofenac gel “as needed”. And yeah, after reading up on possible side-effects I’m going to try and avoid long-term daily use. Want to see if I can minimize inflammation that spurs bone growth while checking on surgical options.

Humorous side note: The doctor was telling me that he used to work with a group of surgeons who started a band (called DNR). The drummer was a neuro-surgeon. I filed that last fact under “Things I Never Want To Find Out Right When The Anesthesia Kicks In”.

 

[definenredefine]

So yeah, X-ray shows the cartilage in the last joint of my right pinky is gone. There’s a nice bone spur developing there.




Doctor prescribed diclofenac gel “as needed”. And yeah, after reading up on possible side-effects I’m going to try and avoid long-term daily use. Want to see if I can minimize inflammation that spurs bone growth while checking on surgical options.

If a provider writes for something "as needed," that's generally a good way to take it. Sometimes, even if it's written to be taken regularly, you can still take it as needed (provided it's for symptom management, like a pain med.) In general, I think it's a good idea to minimize how much/many meds a person takes, as is appropriate based on what condition is being managed.

Humorous side note: The doctor was telling me that he used to work with a group of surgeons who started a band (called DNR). The drummer was a neuro-surgeon. I filed that last fact under “Things I Never Want To Find Out Right When The Anesthesia Kicks In”.

What's wrong with finding out your doctor is cool right before you go under???

 

[Microbass]

I have Psoriatic Arthritis, which is similar to Rheumatoid. It developed from regular Psoriasis and a year or so ago I was prescribed a Biologic treatment.
I had been taking Naproxen 500mg twice a day (before I knew how toxic it was). The Biologic is self injected every two weeks and has been a miracle for me. Thankfully I hadn't sustained significant joint damage and my symptoms literally stopped the first day of taking the Biologic. Thankfully I get this free in the UK, as its hideously expensive. Good luck!

Amgevita by any chance? I spent 2 years with methotrexate and it was killing my liver, so I was switched to Amgevita. Took literally days for me to feel the most pain free I can remember.

I don't know what type of arthritis I have and there hasn't yet been any suggestion from my doctor either times I have brought it up that there would be testing to determine this.

You really need to demand more from your GP, or change altogether, or if your work offers a health cash plan or online GP services perhaps try those routes.

One of those side effects is that turmeric makes for delicious curries. OP, if you're indeed in the UK, the best source of turmeric (along with the black pepper mentioned up thread) is one of the many delicious curry houses I presume you have close to you. Take advantage!

Seriously though, this is good advice. Turmeric (and other herbals, plants, spices, etc) has lots of chemicals and alkaloids in it. Some of them may have anti-inflammatory or other such properties. These compounds tend not to be studied in a systematic way because, frankly, there isn't much money in it. Especially compared to selling raw turmeric as a "supplement" and avoiding any direct medical claims.


I'm sorry your doc hasn't offered more in service of determining what sort of arthritis you're dealing with. I would ask directly the next time you see them. If you still don't get an answer, it may be time to find a new doc.

Good luck! Hope you get some relief.

Personally I believe that diet is definitely a factor, but for rheumatoid and psoriatic these are autoimmune, so very difficult to find out what foods are actually causing the issues and sometimes we find ourselves popping a ton of herbals with no real gain.

That is totally unacceptable.

It took 10 years for docs to figure out my issue - I was in chronic pain for years to the point of being unable to sleep as any movement would cause me to wake up almost screaming. The belief was that I'd ruptured/torn MCL's and they weren't healing or scar tissue was causing friction. I was told not to do the majority of things I enjoyed (skiing, weight lifting). I was on 240mg of codeine and 400mg of tramadol a day. I gave up on the NHS (as much as I fully support it and believe it is being deliberately underfunded). Eventually I went cold turkey on the tramadol (big mistake) and cut my codeine intake to only when required on really bad days. 3/4 years ago I got fed up with my toes being messed up, went to the docs and she said it's likely psoriatic arthritis. Got booked into the rheumatology clinic a few weeks later, x-rayed all over and it was confirmed and they started me on methotrexate. COVID hit and understandably it was difficult going to get this dosage right, but it was never working out. Last year I started on Amgevita and within days the psoriasis across my body reduced by 90% as did the remaining aches and pains. I'm 34 now btw, there was never any real support because no one even thought it could arthritis as my family history only included osteo in the older generations and I had no signs of joint wear. I tried all forms of diet changes, losing weight, supplements. Nothing ever really made a proper dent in the issues.

Moral of the story - tell the GP surgery you need to see one of the docs with a background in all things arthritis, and then whoever you end up with, push for a referral. The arthritis specialists aren't in our GP surgeries.

 

[Mark Ambler]

"Microbass” Amgevita by any chance? I spent 2 years with methotrexate and it was killing my liver, so I was switched to Amgevita. Took literally days for me to feel the most pain free I can remember.

———————

Yes, Humira (Adalimumab), which is the same thing as the Biosimilar Amgevita. I too was on Methotrexate @ 24mgs weekly, and was told to keep taking Methotrexate as it helped keep the Adalimumab working properly. The Methotrexate made be feel nauseous and after reading about it online, it was said that a reduced dosage of 7.5mg would be effective. My rheumatologist said to do this, and so far so good.

I’ll repeat what microbass has already stated. Anyone that has concerns re osteo, rheumatoid, psoriatic, etc, arthritis needs to get a referral to a rheumatologist.

 

[Lostgallifreyan]

That is totally fair, and I definitely should have added existing liver disease as a caveat. My mistake (and a particularly not great one to make as a pharmacist. D'oh.)

No worries. In all my time I don't think I ever saw it on the packet either. Maybe buried in the notes inside somewhere, but it's down to me to know anyway, I think doctors put a great deal of emphasis on family history, and even though I can't know all of that having lost contact with most of it, I can try to remember my own..

 

[Lostgallifreyan]

In general, I think it's a good idea to minimize how much/many meds a person takes, as is appropriate based on what condition is being managed.

I do this whenever possible with OTC meds, not least because if I ever need a prescription for anything, it makes the doctor's choices a lot easier. Timing is helpful to do this too. I'm still wondering why ibubrofen helps me at night but not before anything that stresses my joints. I have an idea about that but I'm open to better ones.

What's wrong with finding out your doctor is cool right before you go under???

I got to pondering that too, and it might not have ideal symmetry.. If I learned a drummer was a neurosurgeon, that's great, I'd rest any worries about precision. Conversely, I might worry. <--- I nominate for possibly the worst drummer joke in the world.

 

[DrThumpenstein]

That is totally fair, and I definitely should have added existing liver disease as a caveat. My mistake (and a particularly not great one to make as a pharmacist. D'oh.)

Interesting. I guess there must be a fair amount of systemic absorption with the topicals.

About 20% of topically applied diclofenac is absorbed systemically. Gastrointestinal intolerance was the most common reason patients discontinue this (besides ineffectiveness. No drug works 100% of the time, and with both systemic and topical nonsteroidals, about 75% of patients report reduction in pain or improvement in function.) I had two patients who had non-GI side effects from topicals of which I became aware. One was elevated creatinine, the other was elevated blood pressure. Both normalized after stopping topicals. Because of this, in the US, topical nonsteroidals have the same blackbox warnings that systemic (oral and injectable) NSAIDs have.

 

[definenredefine]

About 20% of topically applied diclofenac is absorbed systemically. Gastrointestinal intolerance was the most common reason patients discontinue this (besides ineffectiveness. No drug works 100% of the time, and with both systemic and topical nonsteroidals, about 75% of patients report reduction in pain or improvement in function.) I had two patients who had non-GI side effects from topicals of which I became aware. One was elevated creatinine, the other was elevated blood pressure. Both normalized after stopping topicals. Because of this, in the US, topical nonsteroidals have the same blackbox warnings that systemic (oral and injectable) NSAIDs have.

Huh. My experience with topicals is very limited because I work in hospital, but this is very good to know. Thank you!

No worries. In all my time I don't think I ever saw it on the packet either. Maybe buried in the notes inside somewhere, but it's down to me to know anyway, I think doctors put a great deal of emphasis on family history, and even though I can't know all of that having lost contact with most of it, I can try to remember my own..

Paracetamol is a very old drug, and the daily dose limits were, to my knowledge, a hot topic around 10-15 years ago. I remember FDA issuing warnings when I was in school. So it should be on labels now but I can't speak to how prominent it would be.

 

[Old Garage-Bander]

Amgevita by any chance? I spent 2 years with methotrexate and it was killing my liver, so I was switched to Amgevita. Took literally days for me to feel the most pain free I can remember.



You really need to demand more from your GP, or change altogether, or if your work offers a health cash plan or online GP services perhaps try those routes.



Personally I believe that diet is definitely a factor, but for rheumatoid and psoriatic these are autoimmune, so very difficult to find out what foods are actually causing the issues and sometimes we find ourselves popping a ton of herbals with no real gain.



It took 10 years for docs to figure out my issue - I was in chronic pain for years to the point of being unable to sleep as any movement would cause me to wake up almost screaming. The belief was that I'd ruptured/torn MCL's and they weren't healing or scar tissue was causing friction. I was told not to do the majority of things I enjoyed (skiing, weight lifting). I was on 240mg of codeine and 400mg of tramadol a day. I gave up on the NHS (as much as I fully support it and believe it is being deliberately underfunded). Eventually I went cold turkey on the tramadol (big mistake) and cut my codeine intake to only when required on really bad days. 3/4 years ago I got fed up with my toes being messed up, went to the docs and she said it's likely psoriatic arthritis. Got booked into the rheumatology clinic a few weeks later, x-rayed all over and it was confirmed and they started me on methotrexate. COVID hit and understandably it was difficult going to get this dosage right, but it was never working out. Last year I started on Amgevita and within days the psoriasis across my body reduced by 90% as did the remaining aches and pains. I'm 34 now btw, there was never any real support because no one even thought it could arthritis as my family history only included osteo in the older generations and I had no signs of joint wear. I tried all forms of diet changes, losing weight, supplements. Nothing ever really made a proper dent in the issues.

Moral of the story - tell the GP surgery you need to see one of the docs with a background in all things arthritis, and then whoever you end up with, push for a referral. The arthritis specialists aren't in our GP surgeries.

Prior to my getting RA, there was no family history of it. One of my three sisters also has it.

 

[Old Garage-Bander]

I do this whenever possible with OTC meds, not least because if I ever need a prescription for anything, it makes the doctor's choices a lot easier. Timing is helpful to do this too. I'm still wondering why ibubrofen helps me at night but not before anything that stresses my joints. I have an idea about that but I'm open to better ones.


I got to pondering that too, and it might not have ideal symmetry.. If I learned a drummer was a neurosurgeon, that's great, I'd rest any worries about precision. Conversely, I might worry. <--- I nominate for possibly the worst drummer joke in the world.

Fire the neurosurgeon!
(You know it had to be said)

 

[red_rhino]

What's wrong with finding out your doctor is cool right before you go under???

Fire the neurosurgeon!
(You know it had to be said)

Yeah, it was a drummer joke by inference. (e.g. If he’s a drummer, is he really smart enough to be a neurosurgeon?) In actuality, what I should really be worried about is that he follows me on Talkbass and remembers the last drummer joke I posted!

 

[Lostgallifreyan]

In actuality, what I should really be worried about is that he follows me on Talkbass and remembers the last drummer joke I posted!

Too good!

 

[Old Garage-Bander]

I'd be more worried about a drummer being my neurologist, than I would a neurologist being my drummer.

 

[definenredefine]

Fire the neurosurgeon!
(You know it had to be said)

I'd be more worried about a drummer being my neurologist, than I would a neurologist being my drummer.

Speaking as a drummer -

...I'm gonna get so much mileage out of that gif.