I was diagnosed with RA in early October and was given a steriod injection on this day and started on MTX straightaway. During the last couple of weeks, I've been aware of my steriods wearing off and have had some pain/flare ups of my knuckles. Some days I can't bend some of my fingers properly and it just seems to be getting worse day by day. I have been able to live life normally and have been avoiding taking painkillers but I'm worried that I'll be damaging the joints if I didn't take ibuprofen or something. Am I at risk of damaging my fingers if I don't take regular painkillers/ibuprofen? I have been taking ibuprofen the last couple of consecutive days but I know it can't be taken long-term.
Another concern, is my right thumb hasn't been right since pre-diagnosis. It didn't bend properly and then it did start to bend upon force but felt like a popping/elastic band twanging kind of feeling. It hurts when I bend it and I often need to re-straighten it by force using my other hand. I don't know whether to keep encouraging the thumb to bend to enable movement or whether I'm damaging it by doing so. I know I should be asking a doctor about this but I was wanting other opinions too!
Thanks
Jenny
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The metx probably hasn't kicked in yet, can take up to 3 months and it is not a pain killer so you do probably need something else. It is awful when the steroid wears off and the pain comes back, for a short while you can feel almost normal. I was prescribed strong painkillers alongside whatever dmard i was on. Diclofenac / Naproxen both are stronger nsaids that you need to get on prescription and I had a strong cocodamol as well. I can remember checking with my gp about the long periods i was on them and she changed around the nsaids and didn't seem overly worried. As time has passed and I have got medication that is working I have decreased the amount of pain killers and only take them in a flare up. I don't think you are at risk of damaging your joints further if you don;t take painkillers it is more important to take the metx to stop the damage.
I have the same problem with my thumb and fingers, they would click down and I would have to physically straighten it back up again. I talked to an occupational therapist about this - she give me a couple of wrist and thumb splints and these do help. She told me not to straighten my thumb up as this could cause damage.
My advice would be to go to the GP and get good proper advice about pain relief - my gp deals with the pain and the rheumatologist consultant deals with the dmards. Ask to get a referral to an occupational therapist, they look at how you are dealing with having ra and can give you helpful advice and equipment to help you do so.
I agree with Mads you should continue taking regular pain relief and anti inflammatory meds until your mtx kicks in. I was diagnosed May 2011 put straight on Mtx, Sulpha, Hydroxy and 6 months of steroid injections which has overall worked but I still feel the need to take regular paracetamol and diclofenac during periods of pain/flare-ups which is now
I'm afraid I disagree with Mads as I would take NSAIDS to get the inflammation down as much as you can as i've understood it is this that contributes to permanent damage. When joints are inflamed they are pushed out of shape and are much more vulnerable to being damaged, as well as potentially being a sign that you have excess synovial fluid in the joints that's eroding them. It's also nice not to be in pain....
But if you've only been on MTX since Oct, then there's every chance that you'll have a great xmas present and find your symptoms really going away soon. I had a magic moment after about 9 weeks on MTX when I woke up one morning with joints moving and found that grinding aching pain had gone, and my fingers bent again. Polly
I agree with Polly, it's the inflammation that leads to joint damage so talk to GP about a stronger NSAID (I'm on Naproxen) and get a stomach protector with them (Lansoprazole or similar), this limits any chance of damage to the stomach lining from the NSAID. I take 2x500mg Naproxen a day 'cos I'm only 3 weeks into MTX and Hydroxy so they aren't working yet, and the Npx keeps me mobile. Helen
Hi Jenny, sorry to hear you've been diagnosed so recently but at least now you're getting the right treatment. It is early days, you should find your methotrexate will start to do it's job quite soon and the pain and stiffness will hopefully ease. I was diagnosed in May and the mtx has made a huge difference to my condition. Have you had a date given to see the rheumatologist for follow up? I found that my rheumy gave me steroid injections at each visit in the first few months while the mtx had a chance to get into my system and do its job. Like you I also try to avoid taking NSAID's and painkillers choosing only to take them when I really need them. Naproxen causes me to get bad oedema so when I'm feeling the need I take a couple of ibuprofen. There seems to be a bit of conflicting information about NSAID's but the NHS Choices website states "NSAIDs help relieve pain and stiffness while also reducing inflammation. However, they will not slow down the progression of rheumatoid arthritis." You can look at this information if you follow this link nhs.uk/Conditions/Rheumatoi...
You should find that given time and the right treatment you will regain movement in your fingers. My fingers and wrists are my worst affected joints but after a few months treatment the diference has been amazing. If you have been given a contact number for your rheumatology nurse it would be worth calling for advice. Mine are lovely and don't mind me ringing for questions like this. All the best
Paula x
• in reply to
I recall asking about this question when I was in your situation - minus the steroids which I can't take much at all. I was put on Ibuprofen extra strength and Omaprazole for about 6 months while I waited to be diagnosed and then for a few months after I'd started on MTX. My GP felt I needed to keep on top of the inflammation. They worked well for me but unfortunately about 6 weeks after starting the MTX I had a gall stone flare up and my GP was concerned it was caused by the long term use of Ibruprofen so I came off them.
It made a huge difference for the first few days - maybe weeks even. My hands puffed up quite dramatically and I asked on here and other places too because I didn't understand how, if inflammation is the enemy with RA, then why Ibuprofen wasn't also slowing down the progress of the RA too?
I never really got to the bottom of this one out I admit but I think Polly must be right if my hands were anything to go by. Like Paula I find Naproxen gives me oedema but it does really work if I'm desperate. Last time I flared up badly it completely squashed all the swelling within 24 hours - so I don't need it very often at all thankfully but it did work brilliantly for me if I use sparingly on an as and when basis. Tilda xx
I think I had been on and off them for about 4 or 5 months and then on them round the clock for another 4 and then this horrible pain started. But I had only been on MTX for about 6 weeks at that stage and my liver was playing up in the blood tests so I am really sure it was my gallstones in retrospect. They don't give me much jip normally but every now and then they flare up - usually when my diet has changed or I'm stressed - a bit like others have with RA? It just felt like the gallbladder to me but he wasn't so sure so he took me off the Ibuprofen. Then next time my RA flared big time a different GP prescribed Naproxen and Tramadol but I was told just to take them when I flared - not round the clock as before because they felt the MTX would start working more and I wouldn't need them. And for the most part my GPs have been right! Tilda x
HI JennySLT
As the others have mentioned it would be worth speaking to your GP or rheumatology team for further advice on this, but hopefully once the MTX has had a bit more time to kick in you should start to feel some benefit from it. I thought you might find it useful to have a read of our 'Newly Diagnosed' booklet which you can download from the website if you haven't already: nras.org.uk/help_for_you/pu...
Thanks for all your answers. It really is a complicated life isn't it and I'm still adjusting to it all really. I was getting concerned as I'm 27 and the thought of having damaging finger joints terrifies me. I will certainly get in touch with my GP and nurse specialist about this dilemma. I've only seen my consultant on my diagnosis day and I'm not going back til next April. Thanks again for the advice,
Just to clarify - the different NSAIDs aren't "stronger" than each other - its just that the over the counter maximum doses are nowhere near full therapeutic doses that you will get if you have them actually prescribed by a doctor. They are all a little different though, and some people get better response from one than another. It is best if you do get them prescribed at full strength, but then you also need to take them regularly to get the full antiinflammatory effect. As pain killers they are pretty mild, but as antiinflammatory drugs they can be very effective, but only if taken regularly, as prescribed.
Definitely ask about a stomach protecting drug if they are irritating your stomach at all. Also, if you don't feel you are tolerating the first one you try well, then ask your GP to switch you to another - they will all have similar potential effect, but there are a lot of different types available. Because they are all the same group of drugs (NSAIDs) changing from one to another is not really something you have to get a rheumatologist approval for and the GP can just do it for you.
Yes that's all well and good if you aren't also taking DMARDs such as MTX - but if you are it says on all the advice booklets that you should be cautious about also taking NSAIDs and you shouldn't actually need to take them at the same time? I don't know if some of the NSAIDs and painkillers also put a strain on our liver and kidneys but I certainly didn't want to be on both for too long.
Jenny - there's a good piece by RA Warrior about looking after your hands and fingers and I also got a good booklet from my Occupational Health person who came and assessed me when I was newly diagnosed. I got given lots of really useful gadgets and my physio (GP referred at my request) also gave me special splints and advice and showed me exercises I should do everyday to help my fingers unstiffen. I have gone from having a fore finger and a pinky that wouldn't bend at all and were both swelling with tendonitis - to being almost able to clench both my hands now which is a huge difference. It's difficult when it says in my booklet on hand care to respect pain if we are taking painkillers and NSAIDs to lessen the swelling and pain. My physio told me that if I didn't push the one forefinger to the very edge of my pain threshold the joint would soon fuse (it was pretty close to that by the time I saw her) and I would never get it to bend again so I have done as she suggested and it looks and feels almost normal now about 8 months on. She did say that it was a balance between exercise and DMARDs for me and I think she was right. You should ask your GP to refer you for physio and occupational therapy - you are far too young to lose the use of your fingers. Tilda xx
PS but I should add to this that some people do find they need to keep taking NSAIDs but just slowly drop to half the dose they were on before MTX. I think Polly is right to say that it's too soon for you to drop them yet but in time the MTX should mean that you no longer need to take them regularly.
Thanks Earthwitch and TildaT. Yes I know what you mean about the MTX info booklet advising not to take NSAIDS. It's confusing because I queried this when I was at my last monitoring session and they said I could take an NSAID. Definitely need to discuss this further with someone, plus get some physio and OT advice.
Hi Jenny, the tip of my Right ring finger has fused stiff, so I would advise keeping your fingers/thumb moving, but gently & only when you warm up your hands first.
I also think that the ibuprofen could help the swelling or trigger-finger that you are experiencing.
I used to get steroid shots in my trigger-fingers & that helped immensely. It took down the swelling & inflammation & my fingers wouldn't 'stick' anymore.
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