Warfarin and anti-flammatory meds

[AJP_100]

I have APS and take warfarin, I was also diagnosed with psoriatic arthritis but due to only having minor problems and concerns about the interaction declined to start methotrexate medication however now having a flare with painful joint and swelling I am not able to take any anti flammatory meds due to warfarin. GP is to refer me to rheumatology as despite APS diagnosis I have never has ongoing monitoring only been seen when I have flare ups. I feel very anxious about methotrexate and worried about how this interacts with warfarin any advice or reassurance would be wonderful thank you

[Peanut]

hi there. Every sympathy as I am in similar position. I get through the pain with a single dose of tramadol. Just one 50mg takes the edge off. I have looked for alternative pain killers but no joy so far. My rheumatologist suggests methotrexate every year when I see her, but like you I’m too nervous to take the step. I’d like to try medical cannabis which is supposed to help arthritis pain, but in the uk that’s not really a possibility.

Sorry not to be able to provide the answers, but sympathy and understanding I have in shedloads!

[AJP_100 in reply to Peanut]

thank you I am currently in the middle of a flare the worse I’ve had in 25years the joint pain is debilitating my inr is high at moment however think I most likely will try methotrexate as I feel I don’t have many choices at present for pain control I just worry as previously had dvd and pe x

[GinaD]

Because I remain asymptomatic with a low INR, I took the occasional aspirin back when my hip and knee arthritis were down right intolerable. I learned that if I "stayed ahead" of the pain and took tylenol when I could anticipate pain starting later, I could indeed stay ahead of the pain. And if the forecast was for a huge change in barametric pressure, I might take an aspirin or 2 before the weather change And I did get through all that pain and had first the hip and later that knee replaced. I was prescribed methotrexate at one point, but it did not help that much. ( Of course, I did not have psoriatic arthritis.) And, -its been years now --I do not recall that the mexo did much to alter my INR. I did have extra blood draws, but... not much difference.

[AJP_100 in reply to GinaD]

thank you I think I will try methotrexate to try and control joint pain x

[RavenWolfnHoofUSA]

Hi, I understand completely. Recent of diagnosis rheumatoid arthritis. My symptoms were mild however blood work told a different story ie indicates more severe arthritis. I started on methotrexate last oct 2022 with no side effects and MINIMAL relief. Rheumatologist increased from 4 to 5 tabs. Symptoms decreased more however side effects are significant. I will ask for a change in DMARD if there is one with less GI side effects. It's crucial that you ask your rheum about the importance of FOLIC ACID taken with methotrexate. I've experienced NO NEG INTERACTION taking methotrexate with warfarin in the past 5 months. My Dr and pharmacy team are not concerned about any interaction. I believe it'll help, however, don't expect quick results for flares or baseline pain as it takes several months for the therapeutic action of methotrexate. Trazadone is good for pain and I agree it's helpful to take the aspirin. I start out with 2 baby 87mg aspirin at the beginning of a horrific flare. Take good care!Added note:

With regard to warfarin I was diagnosed with primary APS in 2012. I have numerous lows and the worrisome high 4.5- 9. Vitamin K injection brought it down quickly. None were from any medication interaction. I believe the onset of both low and high INRs came from stress stemming from severe painful flares.

Sorry this is post so long. I wanted to give your concerns my experience with methotrexate and a brief history of INR. Hope it helps.

[AJP_100 in reply to RavenWolfnHoofUSA]

thank you for sharing your experiences

[Ray46 in reply to RavenWolfnHoofUSA]

> I believe the onset of both low and high INRs came from stress stemming from severe painful flares

I think this link is often overlooked and underestimated. I have had a spike (over 4) when managing acute joint pain, having elimianted most other causes I mentioned that and the clinic nurse simply said "Ah, well, pain will raise your INR". Until then I didn't know that - but it has noticeably held true since.

[AJP_100 in reply to Ray46]

that’s interesting as INR has been running high for the last month despite reducing warfarin it hasn’t dropped much will look into that thank you

[MaryF Administrator]

Please do book a phone call or appointment with your consultant to talk these concerns through as they can answer your questions regarding this. I have P.A but opted not to have Methyletrexate, I fund my own LDN as I am allergic, seriously so to most drugs. MaryF

[AJP_100 in reply to MaryF]

thank you yes I am reluctant to have methotrexate as I have a hx of dvts and pe i not sure what LDN is ? Could you advise me

I have very painful joints and fatigue as well as blurred vision I was diagnosed at st Mary’s in London by prof Reagan over 30 years ago at recurrent miscarriage clinic and Have no consultant at present INR monitored by clinic and have seen consultants privately during flares but yes I will arrange to discuss further thank you

[MaryF Administrator in reply to AJP_100]

LDN is not often used on NHS, I fund my own, as I had severe allergies to things prescribed, I take it for the mix of my autoimmune diseases, not for Hughes Syndrome/APS, the best place to start reading is here: ldnresearchtrust.org/ MaryF

[AJP_100]

thank you

[Greenmil3]

hi I have Cerebral APS diagnosed 7 years ago and recent diagnosis for psioratic arthritis and on diagnosis my Rhemuy prescribed MTX it has helped a little although my feet are intolerable most days. I am going to ask an increase to 30mg per week next visit as I accidentally overdosed first week and I was a lot better apart from feeling too drugged the next day. I’m not getting much if any side effects but am on a proton pump inhibitor for previous reflux disease and been on pain meds for years due to the amount of pain that turns out to be PA all these years later! But at least I’m on a lot of pain relief already. Amyltryptaline, and Pregablin for neurological pain that was hurting all over my body (at least that’s what they thought back then) amc up to 8 x 30/500 codeine as required. So I would advise get on MTX give it at least 3 months and don’t worry about any interaction

[AJP_100 in reply to Greenmil3]

thank you for your advice wishing you well for the future take care

[Jianna35]

It has taken me quite some time but I am now almost pain free, using diet and herbs. I feel so much better and more positive. Just finished my last dose of Lamictal, so now only on Warfarin. I've had to do it all myself as Rheumatologist is not disposed to believe that you can manage without big pharma meds, I sometimes wonder if they ever consider first do no harm. I'm not against any health proffesionals, but do believe that diet and lifestyle play a big part in our health. I seem to be allergic to a lot of medicines even LMWH which causes thromocytopenia (not sure of the spelling) in me. Everyone is different and have different reactions to all things. Go with your gut feeling and research. Good Luck

[AJP_100 in reply to Jianna35]

thank you