NSAIDs - anyone ? part 2.

[Briefencounter]

I wrote , about a month ago , about groin pain from pelvic fractures ; prescribed naproxen , which proved a life saver for groin pain and RA pain in general ; rheumatologist instruction to taper off naproxen.

I had a rheumatology meeting end July and went armed with all the information gained from this site re staying with an NSAID if it proved helpful .

The consultation , as is often the case , was not with the prescribing rheumatologist but with a lovely nurse practitioner. We went through my notes , x-rays etc . She went through with me the reasons for tapering off naproxen and understood my desire not to come off it completely. I explained that I could manage 1 naproxen followed by 3 days without , until I was in so much discomfort that I needed the next "magic pill". Thankfully , she thought that this plan was acceptable and agreed , although she needed to get the backing of my consultant rheumatologist.

She also suggested that it might be an idea to up my methotrexate from 20 mg to my initial 25 mg (have been on the former for many years now ) . She felt that having a higher prescription might mean I didn't need a NSAID . This too needed to be actioned by my consultant.

So there we are . Thanks for all those who suggested I might like to stand my ground re naproxen . I've also had my first physiotherapy meeting that was actioned back in April , when I first saw the rheumatologist. I'm hoping that will help , as well

[Mmrr]

Good morning, I'm pleased to hear that your appointment went well, hopefully the nurse will be back in touch soon. If not, do chase the response from the consultant up 😏

[Briefencounter in reply to Mmrr]

Thanks , Mmrr , I hope you’re well ! I normally get a letter , outlining the meeting and decisions actioned , about two weeks after a rheumatology consultation . As well as squaring everything with the consultant the nurse practitioner was also going to add a copy of my recent X-ray , showing the resolving fractures , so that I could show my physiotherapist when I met him . Unfortunately, that hasn’t happened and I had the physio yesterday. However , the nurse did say that if my rheumatology consultant disagreed with anything she would ring me immediately . So I guess all is fine and it’s just the problems experienced by our over stretched NHS at this time .

[Mmrr in reply to Briefencounter]

👍

[Lolabridge]

The advantage of taking Naproxen (or any NSAID) without a break is that it has an anti-inflammatory effect as well as it’s painkilling property. If you miss a day you might lose that.

[Briefencounter in reply to Lolabridge]

I understand where you’re coming from Lolabridge but it was the rheumatologist who wanted me to come off naproxen , completely.

I had been on Meloxicam for years without any rheumatologist suggesting I stop . The rheumatologist who put me on naproxen for the groin pain , assumed caused by pelvic fractures , said he only wanted me to be on it for a short time to address the pain . I think possible problems with kidneys , gastric , cardiovascular and my age ( 80 ) were factors .

Naproxen worked so well for me , not only for the groin pain but for my RA pain in general , that I came to a sort of moratorium with the nurse practitioner to take one naproxen with three days off .

I think several people on this site take long term NSAIDs but an equal number of people have been advised to take “as few NSAIDs as necessary, for as short a time as possible “.

Fortunately , this regime seems to be working for me , at the moment .

[Biofreak]

I understand why they say to taper off Naproxen but I still take Naproxen on an as and when required basis if I have breakthrough pain. However, I don't take it daily as generally I don't need to. I suppose you can try what they are suggesting but if it doesn't help keep you out of pain I would get right back to rheumatology.

[Briefencounter]

Thanks Biofreak ( great name ) . I had worked out that the regime of one naproxen, three days off worked for me ( see my answer to Lolabridge above ) and at the moment the medics are in agreement. Although , I haven’t had “the letter” yet . If they suggest upping my methotrexate from 20 mg to 25 mg , I’ll try that . I’m lucky in that my rheumatology team are happy to work with me , rather than just tell me what I have to do .

[nomoreheels]

That sounds like a reasonable compromise. Do get in touch with the nurse practitioner again though if the plan is not quite working as well as it was. Hopefully the MTX dose increase will mean you can reduce naproxen even further, even stop it eventually. Wish I could do this with my NSAID, but as long as I have more benefits than not I’ll keep taking them. I think they're working better on my OA if I’m honest though.

[Briefencounter in reply to nomoreheels]

Thanks , nomoreheels. Yes , that's what the nurse suggested, re coming off naproxen if the "upping" of MTX worked.

I think the naproxen has worked well for my inflammatory markers , as my CRP has been 7 and 10 lately, whereas prior to the change it has been x2 or x 3 higher .

I find all this concern over NSAIDs a bit strange as over the years I've had them changed , diclofenac , meloxicam, naproxen etc , but each move apart from naproxen, has been long term. With no suggestion that this would be detrimental to my health .

When the rheumatologist initially suggested it was time to come off naproxen I asked if I should go back onto meloxicam . He said I should discuss this with my GP .

I have a feeling , rightly or wrongly , that there are "fashions" in RA medication and this is one of them .

[nomoreheels in reply to Briefencounter]

You could have a point. I think I've mentioned before but like you I’ve always had one NSAID or another in my meds. Actually I had 2, one daily & another to take if the daily one didn’t do the job fully. That was only until I saw my Consultant 3 months post-diagnosis but still, I was on 2 daily for a short while.

There is evidence that they can increase the chance of heart & kidney problems but generally we have blood tests which could pick anything renal up, I also have annual heart checks, so we aren't just left to get on with things.

[Briefencounter in reply to nomoreheels]

It was the “stroke/cardiovascular” risks which most concerned me . Most other things , as you say , are covered in my 2 monthly FBC and methotrexate blood tests . I don’t get annual heart checks , which would be useful . I take a BP pill and a statin but nothing else heart related .

[Briefencounter in reply to nomoreheels]

I've just received a copy of the letter from the nurse practitioner re my last consultation .

I was rather disappointed as there was no mention of the discussion we had over my suggestion of "one naproxen day followed by three days off" regime . Which she was going to discuss with my consultant . Just a bland statement that I was aware of the problems of taking long term NSAIDs.

There was no mention of her suggestion about "upping" my MTX from 20 mg to 25mg so that I might not need to take naproxen . Again she was going to discuss this with the consultant .

She had also said she was going to attach a copy of the x-ray of my pelvic fractures to her letter , which I could take to the physio when I had my appointment. So that he had an idea of my problem . There was no attached copy of the xray.

It's so disappointing as the nurse practitioner was lovely . Very friendly , made copious notes and seemed very engaged with my problems . All suggestions of the way forward came from her. However , from her letter , although very pleasant , it would appear that nothing has been actioned and the meeting was a waste of time .

I know the correct thing to do is ring up but I don't really feel like doing this . Usually my rheumatology department is very on the ball.

Fortunately, I have another consultation in October so I think I'll wait until then and carry on with my "regime" . The physio is proving helpful .

[nomoreheels in reply to Briefencounter]

I'm glad physio is helping, just as well. Odd, the nurse practitioner's letter. Makes you wonder. Fortunately it's not too long to wait & continue on current doses etc.