Guest guest Posted April 20, 2006 Report Share Posted April 20, 2006 Hi , I saw some of the class-action stuff on the Internet, and it was a bit worrisome. But I know that Mtx is not without it's dangers too. My rheumatologist seems to be very careful. My liver tests were up just a TINY bit above normal when tested last week, and she ran it again on Tues. (they were normal this time) before she would give me the go-ahead to start the Arava. (which I'm not starting until next Tues anyway, since I'm leaving for a conference tomorrow, and don't want to deal with potential start-up side-effects away from home!!!) She's ordered blood work again 2 weeks after I start, and will see me again 3 weeks from now. She did mention Enbrel in passing, but said she'd really like to try this first, and hold off on Enbrel (or other biologics) until giving this a try. She didn't specifically say that it was because of insurance issues, but the conversation just had that " feel " to it. I had the feeling that if I had pushed the matter, she might have found a way around it, but I really don't have a good reason NOT to be willing to try the Arava, other than the fear of a repeat of what happened with Plaquenil. From what I've heard, ALL these drugs have potentially very bad side effects, ALL of them have other, not so life threatening, but more common and pretty unpleasant side effects, and NONE of them work for everyone. So I guess all you can do is keep playing Russian Roulette until you find something that works without killing you first.<g> > > , don't worry. Many people have gotten very good results with Arava > without experiencing significant side effects. The major drawback of using > Arava is that it is much newer than MTX and all of the potential side > effects and their likelihood are still unknown. Public Citizen has been > calling for its withdrawal from the market, but the FDA is not moving in > that direction. Just make sure you get your testing done on time and report > anything new to your physician promptly. > > Did you and your rheumatologist discuss biologics? Are you sure your > insurance wouldn't cover them now? > > > > Not an MD > > I'll tell you where to go! > > Mayo Clinic in Rochester > http://www.mayoclinic.org/rochester > > s Hopkins Medicine > http://www.hopkinsmedicine.org > > > [ ] Re: Digest Number 5329 > > > > I'm supposed to be starting Arava next week. (the mtx, at least by > > itself, is not working) After all I've read about it hear, I have > > some misgivings. It sounds like the potential for problems with > > this one are even worse than with mtx! > > > > As of my appointment Tuesday, I'm back up to 15 mg of prednisone a > > day, plus Tramodol a lot of the time to stay semi-functional. When > > she refilled my Tramodol, it was for 240 pills! (and my ins. only > > covers a 1 month supply of any rx) In a way, it was nice to know I > > don't have to keep calling for refills, in another way, but it was > > also dismaying to realize that she must think I might need that much > > pain med. > > > > Has Arava at least been useful for SOME people here? Or am I just > > doing this to satisfy an insurance co. that I have " failed " the > > requisite number of cheaper drugs to qualify for a biologic? It > > sounds like this one can take a long time to become effective too, > > and then that it takes FOREVER to leave your system if you need to > > go off of it. > > > > The plan at this point is for me to step the Mtx down to 10 mg per > > week, and add the Arava, first at 10 mg per day, and then if I > > tolerate the side effects OK, up to 20 mg per day after 2 weeks. > > She doesn't want to start with a loading dose (as I guess is often > > done) because my stomach doesn't seem to be tolerating a lot of > > these meds well. So I guess that means it may take longer to see > > any positive effect from the Arava too. > > > > At least on the higher dose of prednisone, I got a decent night's > > sleep last night, and was able to get out of bed this morning. But > > even that made me feel a litle guilty, because I also know what the > > pred will do to me if we can't find another solution before too long. > > > > Because I'm up on a higher dose of pred. again, (and have been > > pretty much since mid-Jan) the doc started me on Actonel to help > > prevent bone loss due to the prednisone. Oh joy, another yucky > > med. THAT one made me mildly sick to my stomach all day, and then > > gave me gripes and diarrhea all night. So now I can't decide... > > Should I take that on the same day as my mtx, and be DOUBLY sick for > > 2 days, or should I take it on a different day, and be LESS sick, > > but for more days of the week? > > > > Also, because my hips have been getting worse and worse, I had to go > > for a bunch of x-rays yesterday, and then schedule an MRI... I guess > > there is a possiblility that the prednisone can cause necrosis in > > the hip joints (and other large joints) and she wants to rule that > > out as the cause of my increased pain. I don't know WHAT they do if > > they find out that's what is happening... I can't imagine how I'd > > function without the pred at this point! > > > > Gosh, this is fun! :-/ > > > > Thanks for listening to my complaining... I DO want to believe that > > when you find the right meds, things get better, but it's getting > > kind of hard to believe while I'm still in the middle of it. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2006 Report Share Posted April 20, 2006 Thanks for putting it in perspective, . I'll let you know how it goes once I start it next week! > > , > > It's true that all drugs have side effects, but, since one can't predict > exactly what will happen in a given individual, one has to go with the odds. > In general terms, some drugs are more effective than others, some drugs are > safer than others, and some drugs have a higher effectiveness to toxicity > ratio than others. > > Public Citizen argues very persuasively that Arava is no more effective than > methotrexate, but is more toxic. And, because Arava is fairly new, the full > spectrum of side effects related to Arava won't be known for a few years. > > Trials only tell part of the story. The " real world " provides the best > information about side effects. Unfortunately, our reporting system is > terrible and voluntary, so it can take years before we fully understand what > a drug commonly can do - good or bad. > > For example, one of our member's cholesterol rose after beginning Arava. Her > doctor claimed that Arava CAN'T do that! Other people reported new > peripheral neuropathy, but their physicians weren't sure if Arava was the > cause. Case reports related to both of these side effects are in the > literature. > > When people here started to use Celebrex, Vioxx, and Bextra, there were many > reports of new high blood pressure. Some doctors were skeptical that the > COX-2 inhibitors were responsible. > > Methotrexate has been in use for RA since the 50s. Its side effect profile > is very well established. Again, we aren't very good at predicting who will > experience what, but we do know what to watch for. > > I'm still astounded that doctors aren't performing a simple chest x-ray > before their patients begin either MTX or Arava, both of which can induce > pneumonitis. Physicians should also take care before prescribing these > agents to people who smoke or who have other lung disease. > > A couple of good reasons to move up to Enbrel (or add it to your current > MTX) rather than over to Arava would be that Enbrel is likely to be more > effective than Arava and less likely to bother your stomach. Too, you may be > able to get off of the prednisone earlier. Of course, the insurance/cost > issue is a huge factor. > > The best of luck with the Arava. Skipping the loading dose is a good idea if > you've had stomach issues all along. Please let us know how you are doing on > it. > > > > Not an MD > > I'll tell you where to go! > > Mayo Clinic in Rochester > http://www.mayoclinic.org/rochester > > s Hopkins Medicine > http://www.hopkinsmedicine.org > > > [ ] Re: - Arava > > > > Hi , > > > > I saw some of the class-action stuff on the Internet, and it was a > > bit worrisome. But I know that Mtx is not without it's dangers > > too. My rheumatologist seems to be very careful. My liver tests > > were up just a TINY bit above normal when tested last week, and she > > ran it again on Tues. (they were normal this time) before she would > > give me the go-ahead to start the Arava. (which I'm not starting > > until next Tues anyway, since I'm leaving for a conference tomorrow, > > and don't want to deal with potential start-up side-effects away > > from home!!!) She's ordered blood work again 2 weeks after I start, > > and will see me again 3 weeks from now. > > > > She did mention Enbrel in passing, but said she'd really like to try > > this first, and hold off on Enbrel (or other biologics) until giving > > this a try. She didn't specifically say that it was because of > > insurance issues, but the conversation just had that " feel " to it. > > I had the feeling that if I had pushed the matter, she might have > > found a way around it, but I really don't have a good reason NOT to > > be willing to try the Arava, other than the fear of a repeat of what > > happened with Plaquenil. > > > > From what I've heard, ALL these drugs have potentially very bad side > > effects, ALL of them have other, not so life threatening, but more > > common and pretty unpleasant side effects, and NONE of them work for > > everyone. So I guess all you can do is keep playing Russian > > Roulette until you find something that works without killing you > > first.<g> > > > > > Quote Link to comment Share on other sites More sharing options...
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