Pain after Depomedrol Injections

I went to see a rheumatologist on Friday.  He injected my knee and wrist with Depomedrol.  The were both extremely painful all weekend but starting to feel better now.  My knee actually felt like it was out of place or very unstable. I was wondering if this was normal.  He said that I have inflamatory arthritis and gave me prescriptions for Methotrexate, and Celebrex.  Can someone be diagnosed with inflamatory arthritis just by exam.  He did send me for blood work but no results yet.  Also can blood work be normal and still have arthritis and can the results change as to wether you are having a flare up or not?  Sorry lots of questions.  I was just a little disappointed because he really didnt go over my history that well.  After feeling some of my joints and briefly talking to me he just said that I have inflamatory arthritis and said this is what we need to do.  I was wondering if anyone else was given inj. and meds. and diagnosed this way?
Any input is greatly appreciated.  Thanks

[spastic]

Hello there, it sounds to me that the rheumy is highly suspicious of an inflammatory process and is having the lab work done to back up his original impression of the inflammatory arthritis.  People can be dx'd just on the physical signs and findings and there are some kinds of arthritis that elude lab tests, like seronegative rheumatoid arthritis, Still's disease just to name a few off the top of my head.  

I wish some doctors would take more time to do a thorough medical history.  I am sorry that he didn't do this with you, he should have.  Do you have access to another rheumy?  It is so important to have a good working relationship and if you are uncomfortable you definately should seek another opinion.

I have Stills disease and the labs almost always come back negative.  It took me taking pictures of rashes and periods of swelling up and documenting fevers, keeping a daily symptom and pain journal to finally get dx'd correctly.  

I do get injections done quite frequently in my hips and back.  I have anakinra injections, and a lidocaine/steroid mix (I can't think of the prescription name for it right now) that one seems to help immediately, numbing the area.  I do take steroids daily to help with my inflammation.

I hope he explained methotrexate to you in complete detail, it is a very powerful drug.  I don't know what to say about him prescribing it so quickly, it doesn't make sense to me.  Methotrexate is not like taking a Tylenol, it does have some pretty serious side effects.  It is a disease modifying anti rheumatic drug (DMARD).  I definately would be questioning his decision to have you start it so quickly.

I hope this helps some.  If you need to talk, you can message me.

Your Friend,

Spastic aka Ada

[Dar584]

Dear Ada,

Thanks for your reply.  I am too very concerned about taking the methotrexate also, this was one of my main reasons for posting.  My neighbor takes it for psoridic arthritis but she is on a very high dose along with Humira.  But I know she has been very concerned about the side effects.  I worry about the long term effect even though he has me on a low dose.  I was just wondering if anyone else was put on this so quickly.  Dont get me wrong the rheumatologist was very nice but I just thought he would be extremely thourough before prescribing an Rx of this magnitude.  He also never told me about any side effects or long term effects of this drug as if he was just handing me some tylenol to take.  The only thing he said was to call if I had any problems with the meds.  I have not started them yet, I am waiting until Friday when I have a weekend to see how they will affect me.  Anyway thanks for your response.  So do you just take steroids and get injections?

[Dar584]

I also forgot to add does blood work fluctuate depending on if someone is having a flare or not?

Thanks

[spastic]

I don't like that he didn't explain the methotrexate in detail to you.  He should of given you pamphlets and a verbal explanation of how the drug works, why he thinks that is the best treatment for you, any serious side effects of the med and even some of the not so bad side effects of the drug.  I definately can hear the hesitation in starting this med.  My advice, call him and have him explain why he thinks it is the best treatment for you.  Tell him your having reservations about it, get him to admit the Why factor.

I have not been given the option of starting methotrexate yet.  My dr's and I have talked about that treatment plan I would like to so I can hopefully get my monster, Stills under control and get my life back. But they are only going to give it to me when the steroids fail.  If that makes any sense.  I have always thought of methotrexate as a last defence kind of drug.

Right now my medicine regime consists of taking 20mg of prednisone 3xday, 800mg of neurontin 3xday, 10mg of flexeril 3xday, 800mg ibuprofen 3xday, .50mg of xanax 3xday, 100mg of trazadone at bedtime to finally knock me out for the night.  I have a lot of pain with Still's.  I usually get my injections when I see my Dr's on check ups and on those days when I just cannot stand the pain anymore.

I should be here off and on for the evening.  Kids and hubby home, things start going kind of crazy now.  Give your rheumy a call.

Your Friend,

Ada
  

[spastic]

I do believe the blood work can fluctuate with flares.  I know I have my ESR and vit D checked at every office visit.  I had a spike this last time with my ESR and I am currently in a pretty nasty flare.  

[Dar584]

He acted like because it was a low dose he was starting at the conservative end of treatment and that we would go from that when I see him in 6 wks.  The funny thing is he never mentioned about having to have my blood rechecked to make sure this drug is not effecting my liver or anything.  I work in the medical field and have done my research.  The one problem I have is that I cannot tolerate Motrin or such drugs on a daily basis they end up ripping my stomach apart.  So I am not sure if that is why he opted for this treatment.  I just heard that it takes a long time to be diagnosed.  While I am glad that he thinks he knows what it is I just wasnt prepared for him to be like it is this take this.  I was wondering about the blood work changing because by the time I finally got into the rheumy I was not nearly as bad as when the flare that made me say enough is enough was.  So I am wondering if the blood work is going to show anything.

Sounds like you are in rough shape, I hope that they come up with some answers for you and help get your Stills under control.  They have you on a lot of meds too.  So I am not sure what the worst of the evils are.  Trying to deal with the pain and risk joint damage, or go on a lot of different meds or trying the methotrexate.  I just dont want to create a new problem from the meds to fix the first problem.  Seems like there should be more alternatives.  I guess I will talk to his nurse tomorrow because I have to call back for my follow up because their computers went down when I was there.  I can ask about my blood work and then talk to her about my concerns over the methotrexate.
Sorry this is so long but it is nice to get someone elses opinion.
It is crazy here too kids, homework, hubby and dishes!!
Thanks for your help!

[spastic]

How are you doing today?  Did you give the Dr a call?  I read an interesting article about how Dr's are trying to give patients steroid sparing drugs like the methotrexate instead of the usual workup of meds.  I guess it depends on the Dr themselves in what treatment they want you on.  

I know that long term use of the steroids can give you osteoporosis so I guess its like as you said I don't want to create new problems from meds to fix the first problem.  Ugh, what to do?  Sometimes I just don't know.

Your Friend,

Ada

[Dar584]

Hi

I am doing okay.  It is funny my wrist that he injected feels a lot better, but my knee has been killing me along with some other joints today. It is also very chilly and rainy here today and that is when I feel the worst.  I did not have a chance to get a hold of my dr. office today, I just got home from work and they are already gone.  I am always so hesitant about meds but this one I am very hesitant about.  I would feel better if given all the info.  There is a lot of info about needing liver biopsies after being on this for a while and that sounds like no fun.  I just wish that there was a solution for all of us without all the risks.
How are you today?

[spastic]

I am having a brain fart, :) I re-read your first post and I guess I didn't see where you said your knee feels unstable or out of place.  Is your knee hot or red?  Sometimes wearing a knee brace will make it feel a little bit more stable.  It can take quite awhile for the medrol shot to work especially if you have a lot of inflammation.  My brain is just not functioning right today, I'm sorry.

Today was a little wierd for me, my aunt and I both see Dr's at the same location so we thought we would conserve gas and ride together.  Bad idea, her car broke down but we still made it to our appts.  We ended up taking it to a local garage and I had to stand on concrete for almost two hours and that always makes the swelling worse.  I wish I lived in a rubbermaid world. :) I am glad that I was with my aunt when this happened, she is almost 80 and doesn't believe in cell phones.  But it was good spending time with her.

I should be here for awhile, the kids are at the library, quiet time.......

Your Friend,

Ada

[Dar584]

My knee is swollen but not red.

Sounds like no fun to have a car break down and have to stand on concrete.
It is good that you were with your Aunt and could help her.

How did your dr. appt. go?

I think I am going to talk to my regular dr. tomorrow first and see if he got a copy of my blood work back yet.  I will get his opinion.

[conntaxman]

I also have RA. and it kills.have it in both hands and the Flar ups are so bad that I can't even pick up the coffee pot.
For months and months I have been reading all I could about RA. and drugs.Also Tring herb med. to reduce pain.They work some.
My rumiee was going to put me on methotrexate and I also had thoughts about that.Then I found out there are shots you can take for your ra.Embrel.something like that.
I told my rumiee i wanted to take embrel, and she told me that it was to strong a drug. and to try the methotrexate First. Yes their are some side effects,but ALL the OTHER drugs also have side effects.TOO many Pills will kill you also.
You said that you were going to talk to the women,hell with that,talk to the DOCTOR. And if he dosent have time for you. then LEAVE and find another doctor.
Also dont worry so much.