My Rhumey Nurse Specialist seems to have a bee in her bonnet about this particular pain killer which I have taken for just over seven years without me noticing any side effects but she says it's a really dangerous drug to be taking and has taken me off it. But it's not kind to your heart or your kidneys or your lungs, but then neither is MTX.
She has also recently put me on MTX injections at a higher dose and I've been struggling.
But there is (so she says) no alternative pain relief, just keeping taking the paracetamol.
I call myself the paracetamol queen as I take so much and isn't this just as damaging.
I am really confused and unhappy as until all of this was decided I'd been doing quiet well.
Any thoughts NRAS Community?
Written by
mickey1
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A lot of medical people have become risk averse to non-steroidal anti-inflammatory drugs especially the later ones like celecoxib because of the higher risk of cardio-vascular events in people taking them.
Personally I think at least some of this extra risk is due to the inflammatory products produced by our own bodies when suffering from Rheumatoid Arthritis and allied conditions and there is some suggestion from some studies that if the inflammatory process is under control the extra risk disappears. But this may be a bit of a complicated, and uncertain way to approach the problem of being taken off the drug by the person responsible for its prescription!
The rationale of reducing your cardiovascular risk would be to reduce your inflammation with auto-immune suppressants (such a methotrexate) rather than a NSAI, especially one shown to have a higher risk.
But the rheumatology nurse will be following a protocol or guideline which is written usually by the doctors in the department, or adopted from other departments and following the NICE guidelines in the UK.
She is not permitted, even if she agreed with you, to vary this, whereas doctors have the greater ability to vary guidelines, But they will only do this provided the reasons are adequately documented and defensible in court. This is in case your relatives decided to sue if you have a heart attack!
How much paracytamol are you taking daily? Did you take PPI with the Celecoxib? NSAIDs are after recent research proven to have more ill effects than thought earlier. Your doc should have explained this to you. The guidlines for paracytamol as well have changed. Take care. Simba
Hmmmm, it's your body and your decision to me. These newer anti-inflammatorys do have an increased risk of heart problems, which is why you should be monitored for cardiovascular risk. I feel she should have explained the risks carefully to you, talked about what can be done to minmise risks, and then let you decide.
I'm also surprised she didn't suggest other NSAIDs of a different group, like Naproxen.
However if you are reliant on painrelief then something is not right, so good that she did suggest changing your disease modifying drugs. But if you are still strugglimg after a few weeks, then ask for yiur meds to ne reviewed.
I have arcoxia, similar to celecoxib, but only take it as & when needed and not all the time. So my doctor is happy to keep prescribing it.
We can keep throwing different sources at one another for a long time but the new toxity level is seen in recent research and taken seriously by the medical professionals. So here is a link again about the subject and if you really want to get thorough information there is a lot you can find in the net. If you looked into both of my links on this page you could have seen that the worry was not about heart attack but of the effect on the liver. Don't know why this was not mentioned in the NHS link.
Not denying that at all - and yes it should be taken seriously.
I just have a growing dislike of companies that are basically selling products dressing themselves up as medical journals and working the technical stuff so they pop up high on the list on google searches. They are usually American, as rules looser there, and whilst the bulk of the information may be accurate and sensible, I've found that often bits of context are missed out so that the information matches their goals. So not lying, but important omissions.
I always look at the info coming out of the US. They are not ham strung by NICE and care pathways. Being an ex nhs governance manager that used to write pathways, I still look at US as they’re far more advanced.
But also not so constrained by rules over being able to prove the accuracy of their advertising. So some american stuff is rather close to the edge, and alarmist.
Very true. Frustrates me though here as NICE are so slow to do anything and there are some amazing treatments and advances worldwide that will take 10 years at least before they’re commonplace in the UK.
Some people like me take other medications which are incompatable with NSAIDS (Riveroxaban) that always takes priority but I was actually shocked after my recent health problems with kidney failre that NSAIDS carry a risk of so much. I don't know why just that it is a life threatening but rare risk so the nurse might be erring on the side of caution. But long term pain relief can't be good surely the RA team can help you get better RA controlling medications as pain relief does not prevent joint damage or the other hidden risks or effects of RA.
It does seem strange that you have been taking this drug for seven years, and you are now being taken off and not offered an appropriate alternative.
Celecoxib is a Cox 2 inhibitor and by design more selective at targeting pain, fever, and inflammation ... and is actually kinder to your gut. Newer drugs like Celecoxib are required to provide lots of clinical data via phase III tests. If you were to put traditional NSAIDS such as Ibuprofen, Asprin, Diclofenac etc. that have been around for many years through the same clinical tests, they would struggle to come to market and would show just as many issues.
Is the Rheumatology nurse in questions new.
Sometimes there are cost pressures which is understandable, however as it is now available as a generic via Teva this should not be as much of a barrier.
In the NHS, there is a big drive under "GIFT" getting it right first time ... it might be worth reminding your nurse about this is you have any problems as you mentioned you were nicely controlled.
The other thing to note is that there is a "risk versus benefit" with all drugs ... and this should be taken into account. If the benefits of you taking Celecoxib out weigh the risks, i would kindly challenge back.
Could be that it will take some time for you to feel the benefit of the increased dose of methotrexate. Would have thought the nurse would have given you an alternative to at least tide you over.
Here in France it is 3g per day. Here some info from the US. You should also read the link above to understand the effect and also what may make you more vulnerable.
I used to take celecoxib for seven years with no side effects, a doctor at the hospital said I did not need anymore and took me off it. A year later the hospital nurse took one look at my knees and put me straight back on to celecoxib to take when I feel I need it for any swollen joints. I always take it with food, but still have no side effects unlike aspirin which caused stomach problems.
Should be ok taken for short periods but NOT together with PPIs, this is what this study shows. Small intestine damage seen in both Naproxen and Celeoxib. When taken with PPIs hemorrhage seen with both.Simba
Very interesting reading. It would be good to see other studies related to this topic in order to get a balanced view. Also the test subject are rats, which may provide insight for use in humans.
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