Saturday, February 02, 2013

Entering a new phase of treatment.... 

Saw the rheumatologist on Monday. The MRI and x-rays taken of my feet last month show synovitis and bursitis, but not the degree of erosion that typically accompanies rheumatoid arthritis. So this is probably arthritis from Sjogren's, which is less aggressive but still needs to be treated as plaquenil has been unable to keep it in check. 

I decided to do the methotrexate as it is an old medication and the risks and benefits are well-documented (plus it's cheap). Due to my needle phobia, I am going to try the pills first. If my stomach can't handle the pills, I will somehow try to get over my phobia and do the self-injections.

We discussed prednisone, but because it could cause even more weight gain than I already have and worsen my diabetes if taken long-term, I will save it for acute episodes only in short courses as I have had success with that. I am hoping that if I can rein in my Sjogren's symptoms that I will be better able to tolerate the fibromyalgia.

So I started a low dose of methotrexate on Tuesday, 10 milligrams. I do that once a week for two weeks and then bump it up to 15 milligrams per week until my next appointment with the doctor in March. If all goes well I will go up to at least 20 milligrams. It can take months for the medication to take full effect, but by going slow I will be less likely to overdo it.

Because of the potential for serious side effects like liver damage, I have to get frequent blood work.  I will be doing labs every two weeks for a month and then if all is well I can drop down to every eight weeks. I have no history so far of any type of kidney or liver problem, even with the various medications I've been on and having multiple ailments that can affect internal organs, but better safe than sorry.

As far as initial side effects go, I've had a bit of transient stomach pain, a bit of vertigo and accompanying nausea on the second day, and some brief bonus fatigue, but nothing significant. I detect an ever so slight improvement in the joints and cognitive function, probably not noticeable to anyone else but me. But even the most infinitesimal change for the better is motivation enough for me to forge ahead.

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