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Palindromic Rheumatism

 

Meds + Treatment for PR

 

Treatment for PR can start with Pain Killers and Anti-inflammatory drugs from your GP. NSAIDS = Non Steroid Anti Inflammatory Drugs (in the form of tablets or gels) don't usually help long term but can help short term with mild pain. The Dr may also start you on an Anti-depressant. The Dr should also refer you to a Rheumatologist for a diagnosis.

Treatment can be challenging because the attacks are so difficult to predict. Symptomatic treatments are the usual treatment. Symptomatic treatment is also called palliative treatment. This type of therapy eases the symptoms without addressing the basic cause of the disease, taken at the earliest part of an attack Anti Inflammatories may help. If attacks are frequent, long-term treatment with disease-modifying agents (DMARDS) such as hydroxychloroquine (Plaquenil), Sulfasalazine (Azulfidine), or other medications typically used in rheumatoid arthritis may be effective.

When you get to see the Rheumatologist he/she will start you on a course of DMARDS = (Disease-Modifying Anti-Rheumatic Drugs) As they don't know what causes PR they don't know how to cure it, so they treat it like Rheumatoid Arthritis "RA". As some people who have PR will go on to RA. They have found that the medication used for "RA" helps with the inflammation and pain and and can slow down the progression into RA (If you are likely to go on to develop RA).

All prescribed drugs can and usually do have some sort of side effect, this varies with what level of drug you take so your Rheumatologist will usually start you with something that has less of a side effect and see if that helps with your PR.

If/After you have tried the DMARDS to no affect or with too many negative side effects or just they aren't working like they used to, you are likely to start a combination. This is usually with another type of drug which may included an Anti-TNF.

Anti-TNF is a name given to a new class of drugs available for the treatment of severe rheumatoid arthritis. Currently this group consists of three drugs, infliximab (trade name Remicade), Etanercept (trade name Enbrel) and Adalimumab (trade name Humira). These drugs work by blocking the action of TNF (tumour necrosis factor) a molecule responsible for increasing levels of inflammation in people with rheumatoid arthritis.

There are other forms of treatment being used with RA and PR, one of which is Antibiotic Treatment. This is a new way of thinking for some in the medical world as "AP Advocates" believe this is a cure for Arthritis and not just a treatment to reduce pain and inflammation which other forms of treatments do. The antibiotics used are usually Minocycline (Minocin). This could possibly work well with people with PR as its supposed to be a good drug in terms of symptom relief and joint swelling relief (and improvement in laboratory measures of inflammation), but it is reported to have no important affect on joint damage which actually it may seem more suited to people that have PR who do not usually get any joint damage like in RA. However this doesn't account for people with PR that will go on to develop RA. Ironically Rheumatologists usually won't prescribe it to people with PR and will only prescribe it to the worse RA cases.

It has to be said to be made clear, no two people are the same nor is PR the same with everyone. This is the same for medication you may take Methotrexate (for example) and have little or No side effects, but some people have problems taking it. This is the same for all forms of treatments and you shouldn't be scared to try a treatment that you think might help you nor should you be persuaded by others to take a treatment that isn't right. Only you can decide and you should always consult your Rheumatologist and Dr.

 

 

Medication Used And Likely Order - Depending On Your Situation

 

These drugs are in no particular order and were taken from a survey of PR Suffers and my own experience. The effectiveness is based on their overall experience and not based on any clinical survey. The more benefit a drug has the more the likelihood of side effects. Not everyone will experience the same side effects or benefits. (Click on the Medication Links to find out more about that drug.)

 

Medication

Side Effects

Effectiveness

Comments

Pain killers, include

Paracetamol (Tylenol,  Acetaminophen),

Codine, Co-codamol, (Panadeine Forte)

Tramadol (Ultracet), (Ultram) (Tramadol) (hydrochloride/acetaminophen) , (Ultracet), (Ultram) (Tramadol) (hydrochloride/acetaminophen), Dromadol SR, Zydol, Zamadol, Zamadol Melt, Zamadol SR, Tramake Insts, Tramake, Dromadol XL, Zydol XL, Zydol SR, Tramal, Tramal SR, Chem Mart Tramadol, GenRx Tramadol, Terry White Chemists Tramadol, Larapam SR, Tramahexal SR, Zamadol 24hr, Tramedo, Tramahexal

Vicodin, Brand Names: Dolorex Forte, Hycet, Liquicet, Lorcet Plus, Lortab, Lortab Elixir, Maxidone, Norco, Stagesic, Vicodin, Vicodin ES, Vicodin HP, Xodol, Zydone

Oxycontin,

Meptid (Meptazinol Hydrochloride)

They can be administered in many forms, tablets, patches and liquids Liquid suspension, chewable tablets, coated caplets, gelcaps, geltabs, and suppositories.

Usually mild to no side effects (or short term effects) with most of the weaker 'over the counter painkillers'. However long term use can cause stomach, and bowel problems (which usually stops when you stop the medication). However  The stronger the medication the more possibility of side effects however longer term use of any pain medication can cause health problems and damage like blood thinning and liver damage.

The stronger pain medications used are usually Opioids/Analgesics like Tramadol, Oxycontin etc.

 

Most pain killers will help ease the pain with mild to low levels of PR Pain. However with PR they don't usually stop the extreme pain. You usually need to take more than one and over a long period. You may also have to take other medication to combat the side effects caused by taking such medication i.e. stomach medication. I have been on a cocktail of paracetamol, codine and tramadol for over 18 months. I have had to stop taking these drugs recently due to IBS caused by the meds. (I have also taken other medication inc DMARDS and NSAIDS so the IBS may be due to the amount of different medication used). I have also experienced side effects from the Tramadol in the form of Nightmares and Dry Mouth etc.

I currently use Meptid (Meptazinol Hydrochloride) instead of Tramadol or pain patches which seems to have less side effects than Tramadol for me.

When you suffer with chronic pain it is very easy to take more tablets than prescribed to help ease the pain but you should always keep to the prescribed dose. Keep a record of what drugs you have taken that day and when you next dose is due. If you are getting any relief with the prescribed pain medication consult your Dr and ask to try  something else rather than keep taking more..

NSAIDS - COX-1 and COX-2 Inhibitors inc

Voltaren;Brand Names: Cataflam, Voltaren, Voltaren-XR

Naproxen (Aleve, Aleve Caplet, Anaprox, Anaprox-DS, EC-Naprosyn, Naprelan '500', Naprosyn),
Ibuprofen, Ibugel, and

Indomethacin ( Indocin, Indocin SR),

Arthotec, Generic Name: diclofenac and misoprostol (dye KLOE fen ak and mye so PROST ole)

Celebrex, (Celecoxib) , Generic Name: celecoxib (oral) (seh leh COK sib)
Brand Names: Celebrex US Link (Celecoxib)
 

Colchicine (used to treat gout),

Ketoprofen (Actron, Orudis, Orudis KT, Oruvail), Link Generic Name: ketoprofen (kee toe PROE fen)
Brand names: Orudis, Oruvail, Actron, Orudis KT (Actron, Orudis, Orudis KT, Oruvail),

Mobic (Meloxicam) , 

Vioxx (Rofecoxib (oral),

Entrophen,

Lodine (Etodolac),

 

The possibility of side effects increase with this type of meds. Usual side effects are stomach or bowel related problems, ulcers etc.. Can even cause inflammation in my case. Mild case of PR can be helped with NSAIDS though other medication is usually needed for best results. I haven't been able to take any anti inflammatory tablets without stomach problems etc I can however use a gel infrequently. They have come out with a different type of anti inflammatory drug (due to the side effects caused with the stomach etc) however I still couldn't take them. Side effects were mouth ulcers, inflammation, stomach/bowel problems etc.
DMARDS

Sulfasalazine (Azulfidine, Azulfidine EN-tabs, Sulfazine EC) 

Hydroxychloroquine, (Plaquenil),

Methotrexate, (Amethopterin  Trexall, Rheumatrex)

Methotrexate - YouTube Video

Gold Therapy, Myocrisin. Auranofin (Ridaura) Aurothioglucose Injection (Solganal)

Azathioprine (Azasan, Imuran) There are more drugs and different names for the above depending on your country and manufacturer of the drugs.

These are all drugs used for other things such as an anti-cancer, anti-malaria etc They have different properties from stopping cell replication and suppression of the immune system etc. Side effects are numerous with each drug. You will need regular check ups like blood tests to check for organ damage etc. These drugs have had an effect for many RA or PR sufferer with reducing the inflammation and amount of flare ups. However most don't last for ever and either the dosage needs to be increased or a combination of other drugs added to have the same effect. I so far have had Sulfasalazine, Plaquenil etc. I am just about to start Methotrexate. Up to now no drugs have helped me with my PR and every drug has had a bad side effects. This ranges from head aches, eye sight and stomach problems.

In the beginning the Methotrexate left me tired etc so I took it at night. After a while the tiredness got to me, not having the energy to do anything or cope with the PR pain etc. I became very depressed and had mood changes. I also took Folic Acid twice a week which gave me a bad tum and IBS the day I took it or the couple of days after. I have stopped the drugs after two months as the side effects lasted too long and happened every time.

Here is a video on YouTube about Methotrexate for Inflammatory Arthritis.
watch-v=1PyX5b3t ... re=related

STEROIDS  

Such as Prednisolone
Prednisone Brand names: Meticorten, Sterapred, Sterapred DS, Deltasone, Liquid Pred, Orasone, Prednicen-M, Prednicot

 

Steroids can/do have serious side effects. They do/have helped with PR Pain and inflammation however they are likely to be used when all else has failed and you have a Very bad flare up. Low dose steroids can be used on a regular basis but not advised due to the side effects. It only takes a few weeks of use to have serious side effects. People who have used steroids say they worked straight away and even though they have serious side effects they would still take them again when in pain. I have never used steroids so far, when I am lying in extreme pain I would like a treatment that would help there and then. However if it was living a while longer without the damage caused by steroids but with the PR Pain I would have to rethink at the time. How I look at it is the steroids are there if and when I ever need them. But to put off using them for as long as I can.
Other Treatments Used

Anti-TNF Therapy

Humira (Adalimumab) Brand Names: Humira, Humira Pen, Humira Pen Crohn's Disease Starter Package  

Enbrel (Etanercept)

Remicade (Infliximab)

Visit Links For More Info. Humira etc is said to be a wonder drug by most of the people taking them.

Humira Injections can be twice a month etc.

Enbrel injections can be once a week.

Remicade "Infliximab" is given by intravenous infusion (that is, through a drip into a vein). You will need to go to the hospital each time you have an infusion. The infusion is given over 2 hours and you will have to wait for another 12 hours afterwards before you can go home.

After the first infusion of infliximab you will have another 2 weeks later and then one 4 weeks after that. After the third infusion, you will continue to have infusions every 8 weeks.

If you are being prescribed infliximab it is recommended that you should carry a biological therapy alert card, which you can obtain from your doctor or rheumatology nurse specialist. Then if you become unwell, anyone treating you will know that you are on infliximab.

 

I haven't been prescribed these drugs yet. They have only recently became available in the UK. They have been used in the USA etc for longer.

I have heard for Humira injections it can help to inject in the stomach where there are less nerve receptors (avoid the area 2 inches around the navel Rotate the injection sites as directed by your doctor. Each new injection should be given at least one inch from the site you used before) and to inject the liquid at room temp. Ice can also be used on the area to reduce pain etc.

Antibiotic Therapy

Such as Minocycline (Minocin) Generic Name: minocycline (mye no SYE kleen)
Brand names: Dynacin, Minocin, Minocin PAC, Myrac, Solodyn, Vectrin

Doxycycline Generic Name: doxycycline (DOX i SYE kleen)
Brand Names: Adoxa, Doryx, Doxy Lemmon, Doxy-Caps, Doxy-D, Monodox, Oracea, Periostat, Vibra-Tabs, Vibramycin, Vibramycin Calcium, Vibramycin Hyclate, Vibramycin Monohydrate

You are advised not to take it if you are pregnant or breast feeding.

There are side effects like with all drugs and these are varied depending on the person and the dosage used. However the long term affect of taking antibiotics are some what controversial and may require certain restrictions on what you can do or things that you must do to maintain there effectiveness.

Visit the links for more information on the drugs.

There are websites out there that are specifically aimed solely at AP (Antibiotic Protocol) or MP (Marshall Protocol) that deal with these areas in more depth.

People that are trying AP Therapy say that they have a good relief from the symptoms But many Rheumatologists do not believe the treatment works.  However it is usually those with RA that use these drugs, and as a last attempt drug.

It is often quoted as a cure by those that are using this form of treatment. But it is something that must be taken for a long period of time and with other supplements to just maintain relief from symptoms.

 

I haven't been prescribed this drug for PR since my diagnosis but had been offered it about 10 years back, but I couldn't take it as I was due to go on a sunny holiday (as the drug can make the skin more sensitive to UV light). A lot of Rheumatologists won't  prescribe it, as they don't believe it is affective in preventing bone damage caused in RA etc. It can be hard to find a Dr who will prescribe these drugs for RA and even harder if you have PR.

For a NRAS article on 'Minocycline Therapy for Rheumatoid Arthritis'  click on link below.

Minocycline and RA '

 

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