What effect do steroids have?

[Cornishrex]

Hi, hoping for the benefit of your experience. I posted a little while ago to say that I have been diagnosed with possible early RA so the rheumy is attacking it early with MTX. I've done three weeks of it so far, first two weeks on 10mg and this last week on 12.5, with the intention of working up to 15mg until I see rheumy again in jan / feb to see what happened.

He gave me a steroid injection in my bum to relieve pain until the MTX kicks in. That was 2.5 weeks ago. He said if the MTX had not kicked in within 4 weeks I could get another steroid injection then.

The steroid worked immediately, the next morning I didn't get that initial stiffness in my hands and feet that I had been getting for the previous 8 weeks.

My question is this. The morning and evening stiffness went immediately, and has not come back. But my hands are constantly sore (my feet to a lesser extent). My complicating factor is that I have a 4 month old baby, and it has been a nightmare trying to lug him around over the last few months whilst suffering from the inflammation. I cannot work out whether the ongoing pain is because 8 weeks of inflammation (in the tendon sheaths: ultrasound showed no inflammation in the joints, or any damage) have meant that my tendons are sore and sort of bruised and they will get better, and that maybe the 16 pound baby boy lugging has exacerbated that, or whether it's part of the whole inflammation thing and the steroids have not completely worked. I really want to get back to doing my yoga, but can't do it yet as I just don't have the hand strength.

Any thoughts / experience?

Many thanks

[nomoreheels]

Hiya Cornishrex. I may be wrong here & someone will put me right if I'm off course because I've always had oral steroids previous to a local hydrocortisone injection in July for trigger finger. It's possible the general injection helped overall inflammation but your specific problematic areas haven't benefited as much as the rest of your body. As an injection can be given in the palm for TF which is caused by inflammation of the tendon sheath maybe if you explain as you have here & the struggles you have with your baby your Rheumy could give you a local steroid injection in both hands. As I say I don't have experience of a general steroid injection but to my mind if he's offered you another if the MTX hasn't reached full effect surely the obvious place to have it is in the joint that's not received the benefit of the general injection. If nobody has any other thoughts on how you could approach this it might be worth asking him?

I hope he can do this so you'll be able to enjoy these early months without little one pain free.

[Hidden]

Hello

I have Psoriatic Arthritis and have inflamed tendons that can cause trigger finger and sore movement. Sorry to say all is power to the course and all I can suggest if they are following the standard pathway the use of TENS and HEAT may be the way forward.

RA causes problems with the immune system sometimes and when you take DMARD this can cause further contraindications. That is why bloods are taken regular to prevent problems surfacing as it stops your body attacking your joints. Steroid injections are a good idea

NSID can be a good idea, they will reduce swelling although not cure the problem. If you are bruising this could be caused by the NSID as that happened to me and they had to introduce other NSID so that I did not bruise. If you have nerve damage drugs like Amytryptalene can suppress that problem.

In the future they may introduce -TNF with a DMARD to give a more positive result

Good Luck

BOB

[Cornishrex]

Right, ok, thanks. I'm not sure what a NSID is. Rheumy originally considered giving me a local injection in my hands (instead of going onto MTX) and seeing what happened - I only have a very mild case right now - but when I pointed out that the pain was also in my feet he decided there was no point in doing that and he'd go straight to MTX and give me the general injection in the bum to tide me over. I have no problem in my feet any more. So I was hoping that someone would confirm my suspicion that the pain is lingering in my hands because lugging the baby has probably exacerbated the tendon pain, and it,ll take a little longer for the pain to subside there. I can't get another general injection for another 2 weeks yet, if I wanted one. it was 4 week gaps minimum.

Thanks for both your thoughts.

[nomoreheels in reply to Cornishrex]

I think Bob means NSAID (non steroidal anti inflammatory). I would certainly see if he will give a local steroid in your hands in 4 weeks then as he was considering it before you mentioned your feet. My thoughts are that your RD is worse/has more inflammation in your hands than your feet at present. If you think about it, your feet are taking your weight plus the babies yet have reacted to the steroid but your hands haven't. I know hands probably normally work more but you're unable to use them normally right now when it matters so you'll be using them awkwardly, unnaturally until the MTX realises it's full potential. I see no point fannying about with NSAIDs when the rest of your body has reacted well or TENS machine or heat as you need your hands free with such a young baby, especially if the alternative is a steroid injection which could offer you better use of them & is a possibility as it has been suggested previously.

[Hidden]

Hi, sorry to hear you're struggling so much right now, it must make caring for your baby really difficult. I can only speak from experience and what you're feeling sounds very similar to the way I was after diagnosis. It's very early days in your treatment so the mtx has not had time yet to build up in your system and do its job.

Like you, I was given a steroid injection when first diagnosed in May 2012 and put on mtx. I was on 7.5mg for 2wks and jumped to 15mg in the 3rd week. I needed two further steroid injections before the mtx got my condition under control. I seem to remember feeling a lot better by the September but my hands and feet were still tender. I asked whether the pain was from ongoing damage and my specialist nurse said it was more likely to be from damage which occurred before I went onto mtx. With time it lessened and I was able to get back to the gym but had to modify the type of exercises I did. I know in Pilates class I had to avoid any exercises which involved weight bearing on the hands.

I would say that lifting your 16lb baby would certainly cause pain. Did your rheumatologist advise using anti inflammatories like ibuprofen or Naproxen until your medication has time to work? If not it may be worth calling the clinic and asking if this would be ok. I found paracetamol and ibuprofen made me much more comfortable but this was under the guidance of my consultant. Hopefully given a bit more time you'll feel a lot better. Best of luck x

[bevolyf]

Hi . Started mtx three weeks ago. I type for a living for past 30 years. Im still sore but have oral prednisone, tramadol, naproxen and omeprrazone in addition to mtx and folic acid. It will take time to kick in

[Chmbrln]

A young baby and starting treatment is hard.you miss your yoga and probably the company.Our local childrens centre does baby yoga for mothers and baby. It may be good to drop in at your local centre especially at a stay and play session. They have a wealth of information.

[Cornishrex]

Thanks everyone for your comments. It's reassuring to get this food for thought. Gosh bev - lots of drugs from the outset. I'm only on MTX. Yes chmbrln, very isolating being diagnosed with this whilst off on maternity leave and not even able to go to my usual 4 exercise classes a week, which is my hobby/passion. Will keep an eye out for baby yoga. In a bit of a rural community so that sort of thing not very widespread.