Yet another anti-inflamatory!

I went to the docs this week as I'm STILL flaring! I've been increasing my mtx: 10 (3-4 months) 15 (2 weeks) 17.5 (2 weeks) -20mg this week. I'm now on 5 days of folic acid also. I've been on Naproxen then diclofenic then Ibruprofen- little to no effect. Steroid injections have never helped; steroid tablets have but obviously can't have too many courses 😒So....back to the docs after a conversation with a very helpful NRAS lady 🙄and I'm now on Celecoxib (with omeprazole first thing.)

I'm to take 100mg twice a day-keeping to the same times, if no better in a week increase it to 200mg twice a day😞3 days into it and no improvement yet. It worried me reading the possible side effects.

The doc even suggested taking omeprazole with mtx- not heard of that before?

Has anyone had any dealings with Celecoxib and Mtx?

🙃

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  • I haven't come across Celecoxib, but I have been on Omeprazole since treatment began. It's a protein pump inhibitor, which reduces the amount of acid one creates in the stomach in response to other drugs. In my case, having got a history of stomach ulcers, it's a very important component of my arsenal. I'm also on Methotraxate (25 mg) and Rituximab. I'm also on 7.5 mg Prednisilone, but am reducing this in anticipation of my knee replacement on 21 June. Jora

  • Hi Moomin. I have Omeprazole every morning and with Mtx with no problems. Sorry can't help with the other. X

  • Thanks for your replies😊I have taken omeprazole before: with Naproxen and Diclofenic but not simply with mtx. Smiler 53, dO you take the omeprazole every morning just for mtx?

    Jora, good luck with your knee op ☺

  • Hi, every morning before food including the Mtx day. It just helps the stomache and any reflux problems. X

  • I've taken many different NSAIDs over the years but celecoxib was one of my first with RD diagnosis. I've found they become less effective over time but my current one, etoricoxib (which is a COX-2 the same as celecoxib) has been my longest prescribed & best to date.

    If you're taking MTX tablets then it makes sense to me to also take omeprazole given that they can upset the tum. I already took daily omeprazole when I started MTX tablets as I've always been prescribed daily NSAIDs since diagnosis so it wouldn't have applied to me.

    Still on maintenance dose steroids, over 3 years now & don't see that changing any time soon in spite of nagging at whoever will listen! x

  • Hi nomoreheels

    When you say nagging people about the prednisolone you're on, do you mean the rheumy?

    I was on a fair whack for a while as I had to come off DMARDS when we were trying for children and when I went back on biologics a maintenance dose for years (5mg) and then I just asked the GP for 1mg and 2.5mg tablets.

    Over quite some time I just reduced them and when I saw the rheumy or GP let them know my current dose. In fact whenever I see anyone from rheumy they ask 'still on this?' 'still on that?'. And I let them know my current regime.

    There has always seemed to be an understanding that if I want to reduce things that's a good thing as long as I do it sensibly and let them know when I see them.

    In fact now I think about it the advice I've always been given is reduce, if you feel bad (meaning worse than you do anyway reducing steroids 🙄) then go back up a bit or all the way.

    7.5mg prednisolone is only just over what your body would naturally provide (about 5mg equivalent IIRC), so as long as you do it s l o w l y and aren't adrenal-compromised you should be ok, in the sense that your body should slowly pick up the slack - if it still can. Just do it by .5mg steps over time. 7.5mg -> 7mg -> 6mg / 7mg alternating days etc etc.

    That has been my experience anyway. if you feel well enough, it's your body after all. None of your medical team want you to be on it, let's face it.

    Regards

    Ade

  • Morning Ade. It's a bit of a long story but when we returned to the UK from living abroad I was in the middle of taking a month's course of deflazacort (3mg), which I previously had on the odd occasion but only ever a month's course. Circumstances were such that there was delay of 3 months before I was able to be seen by a Rheumy here which obviously meant for those 3 months I had no treatment or meds. Once I was signed up, Aug 2013, all my meds were reinstated, including deflazacort, on repeat, I was ok with this as I accepted the steroids were necessary to bridge the gap until MTX took over. Jan 2014 I saw an SpR who agreed to me tapering them. Towards the end of tapering I flared so my GP reinstated them with the intention that at my next Rheumy appointment she'd review my meds. That was in July 2014 when she said to remain on them for the time being. I asked to come off them at my next appointment with her in Feb 2015 & had the same response. This was the last time I saw her as she's been (may still be) on extended leave so I've put it to Locums, Registrars, SpR's & Rheumy nurses, all say it's down to my Rheumy, she's to make the decision so on them I remain for fear of flaring if I did try to taper them myself. That said they've done as they're intended as despite a stressful 2015 I remain controlled in the main, except for some disease activity which is only apparent in my feet, ankles & wrists.....no flares anyhow. I don't tolerate a 2.5mg increase of MTX so I'm currently on 17.5mg injections, 2,000mg SSZ, 90mg etoricoxib, 3mg deflazacort, plus pain relief prescribed for OA - BuTrans 20mcg, amitriptyline 70mg split two doses daily, co-codamol 30/500's as necessary though max dosing presently. Also statins, AdCal-D3, folic acid, omeprazole..... & omega 3 fish oil as my only supplement.

    I've had increases & reductions in doses of MTX, sulfasalazine was recently added but still on steroids, nobody will take responsibility. For the last two appointments it would seem I've been transferred to the clinic of another Rheumy yet still not seem him!

    I have biennial DEXA scans, I'm borderline for osteoporosis, have tried two oral bisphosphonates but because of side effects stopped them with the ok of my GP so not taken any since April last year. At my last appointment with my Rheumy she said she wasn't sure about me having infusions though it has been suggested necessary by an SpR following the results of my last DEXA scan last August but not yet authorised, so just take daily AdCal-D3.

  • Hmm, think I personally, if I felt well enough would just taper extremely slowly. Ultimately it's your body and your choice what goes in it. Obviously I understand the importance of compliance and not 'upsetting' the rheumatologist but in those circumstances they aren't there to upset.

    If you are already borderline OP (are you Osteopaenic do you know?) and unable to take sufficient medication to help with this, plus all of the other problems associated with long term steroid use, then it sounds like waiting indefinitely for a response from someone in your care team is not a realistic option.

    Nobody can force you to take something. Nobody.

    You could always do it by the equivalent of .5mg every third day for a week or two, then 2 days out of 3 etc etc. Slowly slowly catchy monkey 🐒😀

    If you think you are having an adverse reaction to reducing, put them back up.

    I don't want to convince you to do something you aren't comfortable with, and if you had a flare, well, let's not go there. But you gave the impression that you want to reduce but can't for lack of a green light from someone else that, let's face it isn't as heavily invested in the scenario as your good self.

    If it were me, that is all. But that would be my choice, my body.

    Good luck with it anyway.

    Ade

  • Thanks for your help Ade. Not in the best place just now to start as you suggest but once things are a little easier I'll certainly think hard about it & refer to your reply. I am osteopenic/borderline osteoporotic & my last DEXA scan threw up more questions so I know in my own mind I've to do something about it but daren't risk upsetting the apple cart with things as they are at the mo. It's as you say in part compliance but also agree it's my body. Things aren't helped by the irregularities in care, with not seeing my own Rheumy for so long & rarely seeing the same person twice, it doesn't help. Then there's such a long delay in treating & questioning whether I'll have the infusion or not, not helpful. I'm needing to see my GP anyway & she understands how things are so hopefully she'll take the lead & advise.

    Thanks again, we're singing from the same hymn sheet at least!

    Apologies to Moomin for hijacking your post.

  • Yes sorry Moomin 😬

    Good luck nomoreheels 👠😀

  • Thanks Ade.

  • Oh that all sounds familiar to me! My methotrexate kept getting increased til even the highest dose of 22.5 (I think) doesn't ease the pain. I take omprazole twice a day and folic 6 days a week and hydrochlorquine. Have lived on oral steroids far too long and steroid injections never did anything to me. Never heard of Celecoxhib. I luckily (?) Have now been accepted for rituximab and am just desperate for it to work. The alternative doesn't bear thinking about. Keep fighting tho as there are lots of drugs you can try yet. We really are a bunch if drug addicts aren't we?

  • Morning 😊Seems like lunchtime to me as I've been up since 4:30...again!😴

    I'm not convinced mtx will work for me- not sure why I only had that and only at 10mg when I presented seropositive with anti ccp of >340. Seems such a long drawn out start and I'd like to get back to work!

    Best of luck with your new meds- how long did you have to take mtx for before they'd understood it wasn't working? I'm up to 20mg this week and not sure how long it'll take to have any effect if any?

    'Drug addict' seems to sum it up unfortunately 😔I didn't even used to take anything before all of this and the doc's was a place hardly frequented!

    😎

  • Well methotrexate worked OK initially but I don't like the way I feel on them. I guess they were working for a couple of years but as time goes by they have gradually stopped and yet I am told I would be even worse without them. Before I got breast cancer and RA in 2011 I only took thyroxine but now take a cocktail of drugs for both these diseases and they all have severe side effects. I have the following side effects

    Sparse hair

    Severe night and day sweats

    Weight gain

    Brain fog

    Chronic fatique

    Hysterectomy due to cancer drug

    Depression cos of the above

    I take even more drugs to try and cope with these side effects but these drugs have their own side effects too so I just am taking so many drugs now I really feel like a drug addict. Taking drugs to cope with drugs just defeats me. I don't like thinking about it. But I would be dead without a lot of these drugs.

  • Not that I'm complaining

  • Wow! Sounds like you've been through the mill! I suppose we just have to look at today and look forward to tomorrow.

    Ever since one of my sons had liver cancer as a baby I have had that philosophy and try not to get too down even if life can be tough at times x

  • Hi I take omperazole 2 a day along with 20 Mgs methetrexate 4 sulfazalasine a day and 2 hydroxocloroquine a day plus frolic acid 6 days a week , still waiting for funding for Biologics , good days and bad days but very tired at moment

  • Hi popsmith1874, that certainly is a concoction!

    Are they all DMARDS? If so what was your journey to these and what time period? Do you have to come off these before biologics- if so what will you take until then?

  • Yes they are all dmards and I've had RA and oa since 2014 and they will probably keep me on methetrexate along with a biological if I ever get on one

  • We should all open a chemist between us!😆

  • I have been on Naproxen and MTX for spondyloarthritis for a while. My rheumatologist suggested I try Celecoxib instead of Naproxen as I was worried about the latter's effect on gut and didn't like having to take omeprazole with it. There are heart issues with the Cox2 inhibitors of which Celecoxib is one - for this reason my doctor son was adamant I shouldn't take them. However the rheumatologist said that in fact they have a very similar safety profile to Naproxen. As it was, though, I only took it for a week before going back to Naproxen as I didn't find it helped inflammation at all (perhaps because I was only taking 2x 100mg)

    The rheumatologist also suggested I try giving up mtx as it was prescribed when my diagnosis was unspecified seronegative inflammatory arthritis and it does not work on the spine. And in order to see whether it was mtx or naproxen which has helped with peripheral arthritis in knee and other places it's probably best if I stay with the naproxen while I experiment going mtx-free (so far, cross fingers, it's fine)

  • Hi dhall54, I'm pleased to hear all is going well atm ☺

    I'm taking 2x100mg of Celecoxib which I've been told to increase to 2x200mg if I need to after one week. However, I've been told to see my doc in 2-3 wks time whatever happens. I am worried about the concerns re heart etc...but Naproxen did absolutely nothing for me. I am a stong seropositive though.

  • Hi moomin. I'm on mtx and etoricoxib, which is another cox2 NSAID like celecoxib. I have been on the etoricoxib for a couple of years, with a dose of 60mg upped to 90mg by my GP, on my request because my pain wasn't under control, just before I was referred back to rheumatology and was diagnosed. I don't take a PPI with it, which my GP supports, because the etoricoxib is gastro-resistant and there are few if any known gastric problems with it, and because there are known problems with PPIs. (It's a pros and cons situation, and other people think the risks of PPIs are smaller than their benefits). I've never had any problems with the etoricoxib and it has definitely helped me - much better than naproxen or diclofenac, which I had before. I only started on mtx in Feb, and have had more or less constant nausea since then, so I have just been switched from tablets to injections...I've forgotten your question now, but I hope that helps! :D

  • Thanks for your reply flow4, it made me smile😀

    I'm hope the mtx injections make you less nauseous - that's a tough one. I haven't been offered injections - to be honest the consultant didn't even ask if I felt nauseous lol...I'm back there in July so hopefully she'll ask me then! Mtx knocks me for six, especially since I've increased my dose; it makes me feel like I've poisoned myself with chemicals i.e. : my eyes sting and I have an awful taste in my mouth 😫

  • I just want to say that although you feel miserable, you need to be patient. Your dr is actually being quite aggressive, IMO. I had to wait 6 weeks before my dose of MTX would be upped and endured 8 months of misery, since starting MTX, before adding in Humira - and it was only with Humira that I encountered ANY relief! The NSAID I was prescribed at the time was meloxicam. I heard this can be hard on your stomach but I haven't had any trouble myself. Gentle hugs. You will get through this!

  • Thanks Karen77, I did have to wait for nearly 4 months before the first increase, which was so obviously having little to no effect. Then when I went back to the consultant she said "Oh you're only on 10mg!" I'd rung her clinical nurse on several occasions to tell them I was getting worse and not better! Hence, the sudden increase this time: she wanted me to do 1 month on 15 then straight up to 20. I chose to break the jump down, as I did, to smaller increments. Trouble is now, if the Celecoxib kicks in I won't know if the mtx is working😶

    When Humira was introduced for you, was the Meloxicam at the same time? If so, how do you know what's actually giving you relief? And if you don't mind me asking, what dose of mtx are you on now?

    Sorry for the inquisition lol..and thanks for your kind sentiment 😊

  • Arg! I wrote a huge reply and then hit "cancel" instead of "submit reply". Why are they so close together?!?!

    So, I discovered the MTX was actually doing something only after about 20 months of taking it, when I tried to reduce from 4 tabs to 2 tabs (As I went up by 5mg every 6 weeks when in pain, I went down 5mg approx every 8 weeks when I was feeling great). The symptoms returned & I had to add back Meloxicam (which I had also stopped when I was feeling great). By blasting my body with 25 mg of MTX, things got back under control and I was able to stop the Meloxicam. That was great from Nov 2014 to March 2016, except that during most of that time my liver enzymes were higher than normal and even reducing MTX didn't make a difference. I was asked by my old rheumy to stop MTX in early March. In early April, I started to get symptoms returning and I need Meloxicam now to sleep through the night about 5-6 days per week. I'm still on Humira, but that's it. My new rheumy wants me to start leflumonide (Arava) once my labs return to normal, but it's also hard on the liver, so I'm not sure it will be a good option for me. It seems that everyone responds to the medication differently, so we're basically just live science experiments until they can find the "magic" combination that works for us. Hopefully it doesn't take them too long to find that for you! Good luck!

  • I take omeprazole and mtx too

  • Hi linda

    Thanks for your reply. Do you take omeprazole for protection from methotrexate or an anti-imflamatory?

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