ACID REFLUX-ARTHRITIS

[RUSTY750]

I rarely get time to read or comment on posts here ...but this morning I have and have been struck by the number of us who suffer from Acid Reflux ... Is this a chicken/egg situation ? do we get acid reflux as another sideline to Arthritis or is it caused by medication ? those of us with reflux issues seem to be on a wide range of medication and it would appear the only common ground is Arthritis ... thoughts ... ~??

[Fruitandnutcase]

Well, I tend to get reflux if I eat ‘junk’ type foods or too much, fat and sugar. I don’t drink fizzy drinks and try to avoid things that cause reflux - too much chocolate is my biggest challenge.

I think taking my pills with a large glass of water - at least 500ml - to help them down helps me a lot.

I don’t want to take PPIs - if you read the leaflet that comes with them it says they are for short term use and I know a lot of people take them all the time, with their doctor’s blessing, to counteract the effect of other tablets that they are taking (I took PPIs years ago and I had an endless supply of them back then, no questions asked ) and if you don’t mind doing that then that’s fine, I just don’t want to do it. I have osteoporosis and I know they are not good for my bones so I would much rather watch what I eat and take exercise.

That’s my thoughts for what they are worth but I know others will think differently.

[RUSTY750 in reply to Fruitandnutcase]

fair points .. so you think reflux is separate to arthritis or another one of it's tendrils ? .. and not related to meds ....

[Fruitandnutcase in reply to RUSTY750]

I’ve never even gave it a thought that it could be related to my inflammatory arthritis but that’s probably just me. I’ve taken hydroxychloroquine for the arthritis since 2014/5 and a couple of blood pressure tablets.since 2004/5 thing that’s when I was given the PPIs and I took carbimazole for Graves’ disease for a year in 2012 and I take paracetamol fairly frequently for aches and pains. My rheumy said just to go up the hydroxychloroquine with that as and when 🤔

I was prescribed omeprazole again in 2021 when I fractured my sacrum. I was given it along with Naproxen which I was given for the pain - it was agony! After a few days on that I had the worst diarrhoea ever. Doctor said to stop the Naproxen and double up on the Omeprazole which I did but the diarrhoea didn’t stop until I stopped the omeprazole altogether. I’ve done that ‘baking powder burp test’ and I think my problem is that I probably have low stomach acid rather than too much.

As well as the hydroxy and two blood pressure tablets I also take quite a lot of vitamins and minerals for my bones D3, algae based calcium because I really didn’t get on with the D3 / calcium carbonate prescribed by my doctors, magnesium, K2 Mk 7, Omega 3 DHA algae based oil, MacuShield for vision and a probiotic.

So on the whole I take quite a lot of pills daily but as long as I avoid the things that I know will cause reflux I’m ok.

[OldTed60 in reply to Fruitandnutcase]

Some of us here have to take PPIs - dietary changes make no difference if we have high risk of ILD or pulmonary arterial hypertension (lung & heart involvement). I wish I didn’t have to but I have much rarer rheumatic autoimmune diseases with antibody that puts my lungs and heart at highest risk and my gut is paralysed so I’m on nutritional suppliments. I have early osteoporosis but I take Vit D3 and my supplement is very fortified.

In answer to the OP - I think there’s strong evidence now from the likes of Tim Spector that the gut biome is at least partly responsible for a lot of chronic conditions including inflammatory arthritis. The meds we take don’t help but for those of us with conditions such as Sjögren’s and Systemic Sclerosis they can be necessary to prevent damage to lungs from acid spilling back down. Raising bed head is essential and not eating late or provoking with heavy food and drink last thing all key lifestyle changes but are not enough in themselves for everyone.

[Fruitandnutcase in reply to OldTed60]

That’s basically what I said. Some people like yourself have no option but to take PPIs but often (as in my case) they are dished out by doctors when with a bit of effort many people may not need to take them if they alter their diet.

With my family history of osteoporosis and the fact that I was able to alter my diet and not take them , I think patients should be informed in advance about the downside of the medicines they are prescribed and I never was. I do wish the ‘cons’ of taking them had been discussed with me before I started taking them. Low stomach acid ( which can happen with age) can cause similar symptoms yet in my case that was never even investigated.

I feel cross that in spite of several ‘red flags’ for osteoporosis - taking PPIs, having an overactive thyroid with antibodies, then taking a (fortunately short) course of steroids for inflammatory arthritis the link between my various conditions and osteoporosis was never even mentioned years ago when I was younger and could have done more to help myself.

Unfortunately I have learned all that the hard way - too late really and I just think that unless you have absolutely no option but take them I’d think twice about taking PPIs and try following Tim Spector’s advice about getting a healthy gut biom.

[OldTed60 in reply to Fruitandnutcase]

Yes I’m sure you thought you’d covered this but saying saying here that these cause other problems with thyroid and osteoporosis - both of which I have too - is quite upsetting for those who really need to take them but may just feel scared into stopping. Chronic reflux can do a lot of harm as well - as can lots of the meds we are on. Better just to say I don’t need them than to get angry here about your own experiences. It’s swings and roundabouts with all these meds and conditions for each of us here.

[Fruitandnutcase in reply to OldTed60]

I get your point and I’m sorry I have obviously upset you but I so wish that someone somewhere had mentioned the possible downsides of the drugs we are offered and chronic reflux is a terrible and harmful condition to have. My point is that unlike you I turned out not to have chronic reflux yet I had an unlimited supply of omeprazole when all I needed to do was fix my diet.

However I do wish the possible downsides of drugs and even medical conditions were mentioned - either by my various doctors or on websites like this. I imagine I would have ended up with osteoporosis anyway but 15 years ago I had no idea that the medical conditions I had or the pills I was given for them could affect my bones and I would like to have known that so that I could do something positive to help myself.

[RUSTY750 in reply to Fruitandnutcase]

good points again ... perhaps with the knowledge gained over the last 50 odd years more info is available now for those more recently diagnosed ..

[helenlw7]

My gp said my acid reflux was down to my RA meds.

[Amnesiac3637]

They’re a blessing and a curse. Years ago when I was first diagnosed I was on uncoated prednisolone, indomethacin, heavy-duty painkillers etc all of which wrecked my stomach and gave me ulcers. That was in the late eighties when no stomach protection was thought of. I put up with gnawing pains and problems for years and was eventually prescribed Omeprazole or an equivalent to take daily. Such relief!! Unfortunately, I’ve never managed to get off them as the reflux intensifies when you stop and becomes rebound reflux which is sometimes worse than what was originally prescribed for!

I’ve tried many times over the years to wean myself off PPIs but tend to develop gastritis as I am still on drugs which irritate my stomach so will probably now stay on them for the rest of my days. Due to PPIs I have very little gastric acid so my iron stores become low but without them I would be constantly in pain from gastric issues………

My thoughts are it’s almost certainly due to the drugs in the main as, if you’ve got RA, you’ve usually experimented with a cocktail of irritants before you find the right one. Of course diet and sensible eating (or not) plays a big part. If you’re on PPI’s try to make sure you don’t stay on them for any length of time as they’re a b………r to come off. 🤪

[Runrig01]

I definitely think it’s more due to the meds, than the RA itself.

Unfortunately not everyone can come off them. I’m under a respiratory specialist who found that the acid reflux has damaged my lungs, so I need the strong PPI, to neutralise the acid, and reduce the risk of further damage. I take Pantoprazole each evening. She also said to use gaviscon advance rather than regular, as it forms a raft and stops stomach contents going back into the oesophagus. If I miss my gaviscon dose I do suffer more. I’ve been on PPIs for years, had yearly dexa scans for years, and have had no deterioration in my bones in that time.

[Fruitandnutcase in reply to Runrig01]

Im really glad you are being regularly checked out and that your bones are not deteriorating, that is really good news for you 🤗. You definitely deserve a break considering your lung damage.

I so wish I had been warned years ago about the osteoporosis connection between my overactive thyroid, PPIs, inflammatory arthritis etc for a start I would have stayed on HRT, but nope, no one ever asked about family history either.

[welsh12]

I have had acid reflux badly prior to diagnosis I eat quite well no fizzy drinks try to avoid triggers have taken meds many times for long periods Currently off them and take methotrexate and hydroxychloroquine.

[Hisue]

Hippocrates stated >2000 years ago that ‘all disease begins in the gut’. Still true. (& what we put in the gut - food, meds, drinks- definitely affects us.)

[Hisue in reply to Hisue]

P.S. The NIH/USA is doing studies on the connection between gut health & autoimmune diseases.

[Thingybob]

I have just developed what i think is acid reflux.....pain between shoulder blades when swallowing and burping all the time. So interesting reading your comments . I put it down to me being in a flare due to reduced meds.? Seeing the go on weds so ill see what he thinks .

[Hidden in reply to Thingybob]

I have had RA for around 45 years. No reflux problems . However I have been on the waiting list for gall bladder surgery. Since Xmas I have had burping, hiccuaddaddpps, pain in stenum area etc. Then I had a severe attack of cholecystitis. In my case, they think it is my gallbladder causing it and the hospital is investigating. Be glad to get the gall bladder out now. Good luck.

[Hidden in reply to Hidden]

Hiccups. Not sure what autocorrect did to the word here!

[Thingybob in reply to Hidden]

I have now been referred for a endoscopy of my oesophagus. The gp said it doesn't sound like reflux so i need to be looked at by the gastro team at the hosp. He prescribed omeprazole but only after the ' invrstigations' have been done .

[RUSTY750 in reply to Thingybob]

hi.. thanks for making a comment .. i have had scopy's of both ends .. if you get the choice go for the knock out .i managed twice to go with the relax and don't gag but it's not fun ... The plus point was the diagnosis of 'Barretts Oesophagus '[about 7/8 year ago] been on Lansoprazole ever since .. best wishes T.

[Hidden in reply to Thingybob]

Good luck.

[Thingybob in reply to Hidden]

Thank you, booked for 17th may with anaesthetic

[MarshaM]

I have acid reflux lately and never had it before starting Enbrel . I Notice it almost every night when I get ready for bed.

I don't know what PPI is?

[Stills in reply to MarshaM]

Term for meds prescribed that protect stomach from effects of too much and too little stomach acid. Omeprazole is one example

[RUSTY750 in reply to MarshaM]

medlineplus.gov/ency/patien...

[Tkat10]

if I keep my stomach happy then my rheumatoid arthritis is more settled, since finding out I am very intolerant to eggs, lactose and kiwi fruit my stomach is much improved. I also avoid heavily processed and preservatives laden foods.

[Hidden in reply to Tkat10]

Interesting. I have had rheumatoid arthritis for over 45 years. If my bowel and gums are healthy my RA is in remission or quiet.

[Deeb1764]

when I asked my GP he said due to heart and lung issues brought on by RA and steroids he felt it was a mix of medication and the cardio part of my body rather than RA. I know if having bad cardio time my acid reflux higher.

[CallMeSunny]

What is the preponderance of the ‘general public’…those without autoimmune diseases…. Having acid reflux? Judging by the sales of antacid OTCs, very high indeed, I would think.

[Stills in reply to CallMeSunny]

Yes which points to diet as well

[CallMeSunny in reply to Stills]

Exactly! 🤣

[Sarahg62]

well I’m lucky enough to have gastritis, hiatus hernia and acid reflux. Lucky me. Anti inflammatory pills are the cause of my symptoms, so I’m not allowed them anymore. My GP happy to keep me on osemeprazole. I can double up on them when I get a bad bout, but it is so frustrating. I really have to watch what I eat and drink now.

[Kati66]

It’s an interesting question. About six years ago I was put on naproxen and told I had to take Omeprazole to protect my stomach. Three years ago I started with chronic iron deficiency anaemia so was then told to stop the naproxen but stay on the Omeprazole 🤷🏼‍♀️🤷🏼‍♀️🤷🏼‍♀️. Earlier this year I had an endoscopy which showed bile reflux gastritis and a very sore stomach lining. Unlike acid reflux, bile reflux cannot be managed by diet. They recommended I stop omeprazole and start esomeprazole instead. I’m still getting pain under my sternum though.

The problem is, we trust the doctors and consultants and take the medication they give us. If we challenge them, we are most often dismissed.

Kati xxx

[BoneyC]

From 1971 to 2009 I wasn't prescribed any PPI or H2 blocker and did not suffer from any ulcers.

It was my THR surgeon who insisted I should be taking something and from then on I have, currently Famotidine, but have taken Omeprazole.

I think it's the drugs that can put your gut out of kilter, but trying to convince GP/Rheumatologist is not easy. Different brands of drugs, even at same dose, can make a difference but doctors don't like prescribing specific brands etc. Like most things with RA, it's trial and error, but these days I try to stick to a healthy diet, lots of fresh foods, nuts, seeds etc. for my gut health.

[Otto11]

My memory is very patchy but I think I was prescribed Esomeprazole many years ago about 25 when starting on RA meds. It was all oral medication back then. Several years later I was diagnosed with acid reflux but didn’t connect the two. I take Gaviscon ( when I remember) as it rarely gives me symptoms. Only if I have a heavy meal out with wine. I changed to Omeprazole a few years ago after Esomeprazole got some bad press. Simple answer is I don’t know 🤷🏻‍♀️

[Stills]

I was diagnosed with Adult Onset Stills disease in 1979 which is of rheumatoid nature. Steroids, iron , coated aspirin, Indocid, distalgesics , codeine were prescribed for about 5 years. Since then I have self treated joint pain and stiffness with OTC codeine based meds and NSIADs.

Last year I became ill with gastric issues and sudden weight loss. Cancer flagged in blood tests . Omeprazole was prescribed 20mg x 2 daily which I took for 5 months then weaned off to avoid rebound reflux. I remained ill and by Jan 24 after a gastroscopy, colonoscopy, hysteroscopy and abdominal scan no cancer was found.

During that year drs did find orthostatic hypotension and diverticulitis. I’m still unwell and even at hospital they refused to consider Still as an AI condition could be a contributing factor.

I have had acid reflux all my adult life and constipation, both liked to gut issues. I recently read that codeine may be a factor in diverticulosis and that omeprazole may also be a cause. I reserve judgement.

I eat well, but used to enjoy too much wine and gin , alcohol is known to cause reflux so blame myself really.

My humble opinion is rheumatoid conditions are linked to gut issues.

[katieoxo60]

hello RUSTY750, acid reflux is very common when taking inhalers, so guess other drugs may cause it after long term use, think more water as suggested helps plus avoid fizzy drinks ( I do) Reflux is a separate illness called Gerd but why some get it and others don't no one knows

[cyberbarn]

Like many things in life it will likely to be multifactorial. for example some people have a hypermobility condition called Ehlers-Danlos syndrome. Those people often have early onset osteoarthritis. They will have likely been taking painkillers with or without PPIs. Additionally the spincter in the stomach may be weak due to the EDS, which means they are more likely to get reflux, and resultant damage. Additionally taking NSAIDs will have weakened the stomach lining making it more likely that they would get ulcers when taking NSAIDs, and we know that once you have them, you are more likely to get them again.

Additionally, if they have the genetic predisposition for RA/PsA/etc, and your joints have been damaged by microtraumas due to hypermobility, and your immune system has gone into overdrive due to the repair pathways going wrong, and you have say, HLAB27 alleles, you may end up with various autoimmune diseases.

And more additionally, different people eat different diets, have different life styles, and have different cultures and support systems. This will all impact on what happens too.

The study of causal inference captures this in diagrams (Judea Pearl's book of Why explains the maths behind it) but the link below shows a causal inference diagram for inflammation and depression to give you an idea of who these things work.

And one day, if the arthritis in my hands allows, I will have finished my PhD dissertation on medical reasoning which includes a study on causal assertions and how to represent them!

researchgate.net/publicatio...

[RUSTY750 in reply to cyberbarn]

I tried understanding your link - wow .. bit tough for me ..but i guess the water is muddied further by the different reactions of those of us with the same arthritic conditions to a particular med .. ? i.e. - Methotrexate does'nt work for everybody with psioratic arthritis ....

[cyberbarn in reply to RUSTY750]

Yep. That brings in another system. Everyone metabolises drugs differently. The famous one that affects a lot of people is the CYP2D6 pathway where the liver metabolises codeine so the body can use it. Some people do it fast, some do it slow, and some do it just right!

But people who are slow metabolisers so the codeine doesn't work so well, can think that their pain is worse than that of other people, because taking codeine doesn't work for them. It isn't that their pain is worse, it is that codeine doesn't work for them.

Methotrexate will be the same, different people will metabolise it differently.

[RUSTY750 in reply to cyberbarn]

many thanks for the info ...

[Chockyuk]

Well they do say a lot of autoimmune conditions begin with the gut, not sure how true this is. For myself I’ve had a lot of GI problems, I have GERD and have been taking 15mg of Lansaprozal for years. I also had my gallbladder taken out over 10 years ago and I also have IBS.

So who knows really 🤷‍♀️

☺️

[Gottarelax]

I never suffered with acid reflux until I started taking mtx and Sulphazalasine. I switched to injectable mtx and ditched sulpha almost a year ago but apparently, I still have reflux causing a sore throat and tight chest. I've just be prescribed lanzoprosole again. As far as I understand, injected MTX shouldn't cause reflux.