NSAIDs

[crimekate]

Hi all,

I'm looking for some advice/experiences/thoughts about heavy-duty NSAIDs. I currently take opiods for pain (am having to take less since humira, which is good) but in addition to the spine pain I periodically get other joints involved - they swell up and hurt, etc. When this happens, I take fistfuls of ibuprofen, which helps somewhat. I'd really like to take less in the way of narcotics, and reduce my prednisone if I can... so I"d really like to try out some other NSAIDs, in hopes that they will reduce the overall inflammation.

The two I'm most curious about are voltaren (diclofenac) and indocin (indomethacin). When I talked to my rheumy about voltaren months ago, he said I was taking too much prednisone and he couldn't give it to me because of the GI side effects. I'm now taking much less, but still 19 mg/day. I've got a call into him to ask him about it, but I figured I'd get your input in the meantime...

I've tried all the cox-2 inhibitors, they don't touch it. I've also tried Relafen, naproxen, ketoprofen, the megadoses of ibuprofen, and trilisate. Trilisate acutally worked the best, so if he balks at voltaren I might see if he'll go for that. The rheumy is uncomfortable/disapproving of my pain meds (the pain specialist pushes those) so I'm hoping he'll work with me. Of course, I don't want to destroy my stomach in the process.

Any advice is appreciated! I hope everyone is having a good day today.

kate

[jdgarwood]

Hi Kate,

Have you tried Arthrotec? Its a combination of Diclofenac and Misoprostol. The Misoprostol protects your stomach from the irritating effects of the Diclophenac. I too tried all of the Cox-2's and just about every other NSAID out there. Voltaren really was brutal on my stomach, so my doc switched me to 75mg of Arthrotec twice daily. I've been taking it for almost two years and it has worked great for me. You can read about it on WebMD...http://www.webmd.com/drugs/drug-5080-Arthrotec+50+Oral.aspx?drugid=5080&drugname=Arthrotec%2050%20Oral.

Hope this helps.

Joel

[crimekate]

thanks Joel!

I had not heard of Arthrotec, that definitely sounds like something worth looking into.

[KyWoman]

I tried diclofenac, sulindac, arthrotec, and naprosyn before I finally found that etodolac (Lodine) works pretty well for me.

I think you have to keep trying to find one that's right for you. I have a friend who swears by arthrotec, but it didn't help me at all. Every person's different in what helps them.

[crimekate]

Thanks for the reply! I understand each person reacts differently, but have you had any stomach/GI issues with the Lodine?

[tmartha]

Hi, all -

I've been on etodolac (gen. for Lodine) also since May '05 - 400 mg. twice a day. Have not had any stomach troubles or other side effects. Ibu stopped helping, naproxen and relefen never touched it, sulindac made my skin crawl with itching. Lodine helped after 2 1/2 weeks. But did not help enough, so 3 weeks ago added 12.5 mg. of Mtx a day. And starting 3 days ago I'm feeling better than I have in two years! Can't believe it. Somebody pinch me!

Best of luck to you, you'll find the right mix of things eventually - keep hanging in there and don't settle!
Tani

[JesseLou]

Tani - did you mean 12.5mg MTX per week?

[tmartha]

Ouch - Yes, Jessie Lou - thanks for the clarification! Past my bedtime.... :)

[crimekate]

thanks to everyone for your responses. I'm still playing phone tag with my rheumy, but I'll update when I get an answer.

[crimekate]

So I finally got a chance to talk to my rheumy. He won't let me have the prescription NSAIDs while I'm on this dose of prednisone. The concern is GI troubles. He said I'd have to be down to 10 mg to try Voltaren or somesuch.

The trouble is, without another anti-imflammatory, I won't be able to get to that dose of prednisone. I'm basically stuck. I had hoped that a strong NSAID on a regular basis would curb the systemic inflammation, thereby allowing me to reduce my prednisone dose. I'm not really having problems with the pred (a little rounding of my face but it's only noticeable to people who've known me a long time), but I'd rather not take it. I can't just "tough it out" - I"m functioning at a really high level on all these meds, and I just can't afford / am not willing to feel like crap and not be able to do things. SO - I continue on at 19 mg/prednisone per day and narcotics for pain.

The other reason I wanted the NSAIDS is that when various joints swell up, the narcotics don't really address THAT - but ibuprofen helps somewhat with the joint swelling and pain.

I really hate having to take all these meds. I also hate my "drug pusher" (Aka pain specialist); my desire to not take the narcotics has less to do with my discomfort about taking these meds (I"m basically over that) than my desire to not have to go see this idiot once a month. BUT - that's not going to happen, I guess!

Anyway, thanks to everyone who weighed in.

[ouchyk]

Kate,

Just a thought;

I had read some literature about pennsaid. I'm not sure that its available yet in the US and I keep meaning to ask my rheumy, it's a topcial nsaid that is in approval process ( or might be already approved? ) for osteo arthritis but being a topical nsaid could be helpful? it's not suppose to have GI effects.. Wouldn't hurt to ask if it's available.

http://www.nuvoresearch.com/products/pennsaid.asp

Not sure anyone would want to apply this medication to where psoriasis exists " With topically applied Pennsaid®, the most common adverse reaction has been mild dryness or irritation at the application site."

Hang in there. Have a good weekend.

Karen

[crimekate]

Karen,

Thanks for the thought; I was really angling for something to suppress the inflammation on an ongoing basis (which is what the prednisone does) that might also have the added benefit of getting the pain levels down to the point where I don't need to be dependent on narcotics.

I do this to myself periodically. Most of the time I've accepted that I have to take all these meds, and realize (all the time) that I'm doing FANTASTIC compared to where I was a year ago; but then I get these fantasies about how I can minimize/do away with the meds in one way or another.. the PA sufferers' version of a get-rich-quick scheme, I suppose. I do know how lucky I am to have found a combination of meds that I can tolerate and that allow me to have a relatively normal life, but sometimes I resist...

At least I don't get overly hopeful about going into "remission" any more. that was my hope when I started biologics, and I suppose it happens to some people, but it ain't happening here.

Just a little self-pity today. Thanks for listening.