Supposed inflammatory arthritis and fear of drug interaction with Apixzban , Digoxin and Losartan .

[Luludean]

mitral valve repair in 2000, persistent AF i 2010.

For past 5 years increasing joint pain . Diagnosed with multiple forms of Rheumatoid arthritis , Psoriatic, ankylosing, facet joint disease etc , now CPPD. Second different hospital contradicted the “rheumatoid” disgnosis and said I had Osteo arthritis. I had bad side effect from Humira injections( constant uti s, Encerecept caused chest pain ( probably bad acid reflux). I refused Methotrexate . Apart from steroid caudal injections and a short course of Prednisilone I have had no rheumatoid drugs at all for 2 years. Apart from heart disease and persistent AF ( which is controlled by Apixabam, Dogoxin and Losartan ) I have painful boney lumps on feet. These cause terrible walking and this affects my back and pelvis.

Now I am told I will be put on Leflunomide. I am very worried , of course I have looked it up , the side effects seem to be cardiac . I have to prioritise heart over bones. Also, it sounds petty but , alcohol is banned.

I have been told on a telephone apointment 2 days ago that there is NOother drug I can take . The next face to face appointment with the nurse practitioner is purely to be instructed on taking this drug. If, I do not accept this I must cancel the up coming , end of September apointment. In her visit summary my consultant wrote that my symptoms were of osteo arthritis.

I can not be the only person with several “ co- morbidities”. I hate that word . Advice please.

[Cavalierrubie]

This is a terrible dilemma for you. I am not familiar with the drugs, but if l was in that situation, l would go back to my cardiologist and ask for his advice. The cardiologist should liaise with the arthritis clinic to ascertain the best course of action. Perhaps he can review your heart medications. It’s not a decision that you can make alone and if this medication can have cardiac side effects, l would think your cardiologist needs to know what they are suggesting for you. Failing that, l would have a private consultation (you can be referred back to nhs) to find out what is best for you. Take care and hope you get somewhere with this.

[Luludean in reply to Cavalierrubie]

Thank you Cavalier.. My cardiologist did step in 2 years ago when I was on constant anti bios for uti s. He phoned and said I must ask gor a multidisciplinary consultation . The consultant rheumatologist then, in A face to face ( second and last I had with him) Refused.

I would not change my heart drugs!

[Fullofheart]

I have had AF for 20 years which led to heart failure and only just attained normal rhythm following 3rd ablation 15 months ago. Now out of heart failure.I was diagnosed with rheumatoid arthritis in February following months of pain and inflammation. I was put on steroids which I am now slowly reducing and I started on methotrexate in April. I've put on 2 stone thanks to steroids (despite no change to a very healthy diet) and I've been worried about that and about the meds causing AF to return. However in talking to rheumatology, cardiologist and EP they all feel the inflammation is more of the risk of AF returning than the meds or associated side effects of meds.

My EP felt getting the inflammation under control was the key as RA and AF can often go hand in hand, with RA causing AF due to the inflammation.

Hope this helps.

[Luludean in reply to Fullofheart]

Wow , thank you Fuulloheart.

You seem to be very well looked after.

I would mot have another ablation . Tge ones I had in St Marys were very long and both failed .Lovely man did them and was most upset that they had failed .

I do not have an EP. Not seen a cardiologist for 3 years but!! Seeing one end of September. As I wrote , my then rheumatologist refused a multi disciplinary consultation .

Hence my dilemma. L

[Fullofheart]

I haven't had a multi disciplinary response, I just spoke to them all separately.The EP who did all 3 of my ablations just happened to be ringing as a 12 month review.

My cardiologist is very good at responding to me but he didn't think he needed to talk to the rheumatologist either.

I think, based on my experience, your main goal will be to get getting the inflammation under control. Which will, invariably, require medication.

Good luck.

[Luludean in reply to Fullofheart]

Thank you fulloheart.

I trust cardiology , one mitral valve repair and persistent AF down the line. No EP person but I still have faith in that department. They saved my life in 2,000. Gasteroenterology , pain clinic , gynae, all yreat me as a human being .

I cannot say the same for rheumatolgy .