RA Symtpons

[duckers]

I was recently diagnosed with hepatitis C.  I went to my primary Dr. because of joint inflammation and pain that migrated around my body and was first diagnosed with RA.  The rhuematologist asked about HCV and had me tested.  I was "blown away" with the positive results.  Since the diagnosis I have seen a gasterentologist and have seen my rheumatologist.  The rheumatologist believes that the RA is a sympton of the HCV.  I have had a liver biosposy and I am getting ready to begin treatment for the hep C .  My question is this, the pain from the RA is unbearable and debilitating.  I have been prescribed celebrex for the inflammation and tylenol with codeine for the pain.  Neither appears to have any effect.  Ibuprofen and Naproxen do not work.  The Dr's want to start treatment soon as they believe this will help the RA.  Any suggestions for dealing with the severe pain from the RA.  Thanks.

[msleesa]

How are you all doing? I just came upon this forum, and i am so glad I did. I too, have Hep C, diagnosed in 1992 when test first came out. I am lucky, stays pretty well behaved.
Last year i had tests done, RA was 116. Dr. was very surprised at how high, now reading this forum it all makes so much more sense. thank you all for being here, (at least I sure hope you are all here) Please post and let me know how the 3 of you are doing, i found your posts very close to my heart, as i too understand.

[FloridaMouse]

Good luck to both of you.

Mouse

[alagirl]

I've developed, or am developing RA as a result of treatment for HCV.  I am glad to see that more rhemy's are finally starting to test for occult HCV when they see RA.  It should be a part of every work up for RA in my opinion.

Anyway, back to the pain issue, its difficult for me to assess what type of pain I'll be in after I finish treatment.  At the moment though, when you add together the pain from the huge amount of epogen I take weekly, the interferon shots, and the new case of RA, I have what is sometimes unbearable bone and joint pain.  I personally take very strong pain relievers.  I have both morphine and a demerol/phenergan combination at my disposal.  I started out with hydrocodone, and it just didn't touch all of the bone pain.

Since I felt I had a lot of different things causing pain (I have migraines, then started chemo, which can be painful, and then started having the RA symptoms), I stopped asking my different specialists for pain medication and just rolled everything into one pain management doctor.  He's been great.  The first intake with him was a little long because they need all of your history and tests first-born child and everything, but after that its been nice to have him handle all of my pain medication.   And for the first time since I've been in treatment for HCV, I've had a week that at least physically, was pretty pain free.

After I finish treatment I would imagine I'll be able to use far less pain medication, although I realize that the RA may always be there now.  So in another nine and a half or ten months or however long it is til I'm through, I'll get him to reassess me.  For now though, its just nice to at least be feeling a little bit better on treatment.

[duckers]

Thanks for the response.  I am currently not taking any meds except celebrex for inflammation.  The Dr's stopped the methotrexate and prednisone as soon as they diagnosed me with Hep C.  About 2 weeks after they stopped the methotrexate and prednisone (which I had taken less than 2 weeks) the flare ups began again and have gotten worse each week.  I asked about the prednisone--thinking that they stopped it because of the liver disease but the Dr. explained it was because in prevents the TX for Hep C from working.  The Rheum. says there has been no damage to my joints or cartlidge, the swelling, inflammation and debilitating pain comes and goes and so far has done no damage.  This is why they want me start treatment ASAP.  I won't take anything narcotic, clean and sober for 21 years and I am afraid of consequences.  I have had 2 knee surgeries, foot surgery and an appendectomy and the strongest medication I took was advil so I know I have a tolerance to pain.  I am not sure how much more I can take.  

[CMcH]

The RA is what really pushed me into getting ready for TX. I just had a biopsy in late Nov. and have an apt. w/GI NP next week. My family doc thought the jt. stiffness was from Menopause. Then when I wanted to be tested for Lupus because my mother had it he found the RA factor. I waited a couple months and then saw the only Rheumatologist on my plan, and he just blew it off and said it was from the Hep C no meds, nothing! My jts. have been hurting for about 1 1/2 years. I used to run marathons and now I can hardly run. I cannot make a fist in the AM or straighten my elbows. It hurts to write or type! I take a lot of hot tubs and they seem to help.
I had never heard you cannot TX w/Interferon when you have RA. I have heard that it will probably exacerbate it though. Not looking forward to any of that. My Thyroid is already gone! I plan on starting TX after the holidays.
Let me know if you hear any thing else about RA and TX.
I just want to feel better and I'm willing to feel wors to get there.

[FloridaMouse]

When y ou see your rheumy, see if you can get him/her to prescribe Humira or Enbrel to go along with your current cocktail.  Shands at the University of Florida said that there are reports out that suggest the biologics such as these to help make the interferon work better.  If your insurance company balks, have your doctor explain to this that you cannot take high doese of methotrexate 'cause you have liver disease, therefore, you need to take the Humira along with low dose methotrexate in order to try to slow down the progression of your disease.

My hands, elbows, feet and knees have been affected.  I have no cartilage left  in my left  knee and I expect the right will follow suit very shortly.

Missy

[duckers]

Thanks for the reply.  My rheumatologist thinks that the RA is a manifestation of hep c.  I was first diagnosed with RA and she raised the question of hep c.  The liver biopsy came back low for inflammation.  My gastro. did not give a stage or grade for liver disease.  All test have come back in the normal range with the exception of my viral load.

I have been experiencing the RA symptons for about 3 months.  There is no RA in my family history at all.  Both my rhuem. and gastro want to start treatment right away to see if there is any impact an the inflammation of my joints.  In fact this is my only sympton that I have really experienced with hep c.  

The joints that are most affected are my hands, elbows and feet.  Heat tends to aggravate the pain.  Sometimes cold numbs the pain and helps to relieve it but not always.  Celebrex has done nothing for me.  The pain migrates around my body and lasts for about 48 hours before moving to the next area or going away completely.  No pain medication has really helped outside of the prednisone they put me on at the beginning of treatment for RA.  They have explained that prednisone cannot be taken with the treatment for hep c.  

I have an appt next week with the rheum.  I intend on pursuing this with her.  Any other input is welcome.  



  

[FloridaMouse]

What is your stage/grade of liver disease?  Interferon is contraindicated (a no no) for heppers that have a confirmed case of RA.  I just went through all this.  I would up with RA after   my first round of treatment.  My GI would not treat me unless I got clearance from a major teaching/research facility.  I just went to Shands at the University of Florida on November 13.  Again I was told that Interferon is contraindicated in patients with RA.  The only reason why they are going to let me try to treat again  is because I have advanced liver disease and its my only choice.  I was told that I would most likely become cirrhotic and it would most likely be life threatening within the next 5 to 10 years.   Since there are no treatments coming down the pipes in the next 5 years that do not include Interferon I have no choice but to do the interferon.  If I were you I would not try treatment again unless you have pretty significant liver disease.  Treatment will make RA worse and it will be VERY painful.

I take methotrexate (which is VERY hard on the liver) at a very low dose as well as Humira to keep my disease from progressing.   For debilitating inflammation they normally recommend a short course of Prednisone.  Unfortunately, steroids cannot be taken while you are on treatment.  Celebrex  is a good anti-inflammatory for heppers on treatment as it is non-steroidal.  Shands also told me that there are reportst out there that sugges the new biologics (Humira, Remicade, Orencia, Enbrel, etc.) actually enhance what the interferon does.   There is of course no "proof" of this yet so Shands will be following my progress throughout my treatment with my local GI.  Have you talked to your doctor about getting on one of the new biologics?  I was able to get on the Humira right away because my liver is so bad they can't give me anything above the minimum dose of methotrexate.

I don't expect that you would get much relief from Tylenol with codiene as far as your pain is concerned.  RA pain is too severe for medication like that.  I take Ultram/Tramadol for my pain.   If your pain is in your hands  you may want to try getting a parafin wax treatment center, warm baths may help your body and most important if you are swollen, red and inflammed do not force yourself to use that joint, it will only serve to cause damage.  If you are not swollen, red and  inflammed try to do light exercise of your joints, range of motion is particulraly important.  My orthopedist made custom removable plaster casts for my hands, I use a cane for walking when I have too.  Some of these suggestion are pretty basic but I hope they help.

Good luck to you.

Mouse