Actemra

[Leeleep]

Actemra has been really keeping my pain tolerable, however I needed a crown and was advised to discontinue my weekly shot two weeks prior to procedure. That was on February 26. I’m still off because the crown is not back from lab. I’m struggling severely with pain the last two days. This certainly proves to me that the shot works. Im going to call the company and find out if I can start up again because I would think the installation of the new crown should not be an issue. My appointment is 10 days away. 💜

[jinasc]

Two questions:

What was the reason for discontinuing the Actemra?

I assume you are still on pred for the GCA or do you have both OMR and GCA, also what dose of pred are you currently taking.

[Leeleep in reply to jinasc]

Dental work. A crown. Prednisone 8 mgs.

[SheffieldJane]

Hi, I wasn’t aware that you had to stop Actemra for dental work. Alendronic Acid yes.

It is interesting and encouraging to hear that Actemra helps your pain.

I think your plan of action sounds good.

[PMRpro Ambassador in reply to SheffieldJane]

Stopping taking alendronic acid to have dental work is actually fairly pointless - once it is in the bones, it is in the bones. And the evidence thus far is that it will still be there the day you die...

[SheffieldJane in reply to PMRpro]

How depressing. I thought I had read that advice here from someone’s doctor. I hope I dreamt it.

[PMRpro Ambassador in reply to SheffieldJane]

Isn't it? But even with AA, you wouldn't need to stop for a crown - it is only for invasive surgery, like having implants. But the problem there is that it isn't entirely clear in advance whether the bone would heal around the implant anyway once AA has been used. Which is MY main concern - they really aren't aware of the potential problems years down the line.

[Leeleep in reply to PMRpro]

I use Forteo. Does it have alendronic acid?

[HeronNS in reply to Leeleep]

Forteo is teriparatide, it is not a bisphosphonate, but they are concerned about long term side effects, cancer showed up in the lab animals, so restrict the length of time it can be used.

[Leeleep in reply to HeronNS]

They only allow you to be on it for two years. Nobo

[HeronNS in reply to Leeleep]

You are quite right. I'm correcting my post above. Forteo is teriparatide and you can only take it for two years. They are not sure whether it will cause cancer, and so they are being extra cautious.

[PMR2011 in reply to SheffieldJane]

Good luck with the crown Leeleep. Dentist visits are not high on my list of enjoyable activities! For dental work staying on Actemra and Alendronic Acid should be okay. It’s dental surgery you need to consider stopping. The Actemra because of the immune suppression and alendronic because of the potential side effect of jaw bone necrosis.

[Hindags in reply to SheffieldJane]

Actually, I didn't have to stop AA for a crown. A crown is not an invasive dental procedure if it doesn't include a root canal. Consulted with two dentists, endocrinolgist, and bone specialist. I was taking 9.5 mg Pred for PMR alone. I had been on AA about ten months at the time. Never have taken Actemra so that wasn't an issue. If there isn't an interaction between actemra and AA and no complicating factors for the crown...I am confused the recommendation too.

[SheffieldJane]

I am probably thinking of my own front crowns that did involve root canal work. But as PMRPro has said AA stays in your body forever. It is a consideration though because I understand that some dentists are reluctant to treat if you are on AA. Or have I got that wrong too? I mean dental surgery really because of the jaw necrosis risk as PMR2011 points out.

[Leeleep]

They only allow you to be on it for two years. I never heard what you are saying. That really concerns me.

[SheffieldJane]

I expect that having a crown fitted is going to be fine. I didn’t know about AA making a permanent change though.

I was really pleased with my crowns, they were better than the teeth they replaced.