Friday, July 12, 2013 maryff, Community Member, asks

Q: RA and Eye Health

I have rheumatoid arthritis, fibromyalgia and just recently diagnosed with achilles tendonitis in both feet. Since my initial dx almost a year ago I have been on prednisone, 20-30 mgs due to inflammation. In the past three to four months I have been able to go down to a maintenance dose of ten mgs. Due to the inflammation in my feet the podiatrist recommended and my rheumy agreed to bump it up to 20mgs. In the past couple of months I have been experiencing migraines and persistent headaches. I reached out to my primary doc and she suggested an opthamalogist. I had my appointment today and the opthamalogist found high pressure in both eyes (26&27) gave me eye drops to reduce pressure, set an appt for two weeks to re check pressure and set a goal to take me off prednisone, this being her root cause for the increased pressure. I have not had success in tapering my prednisone from 10mgs, when I have tapered to 5mgs pain has returned tenfold. I am concerned with this game plan of taking care of the eye pressure I will end up in a worse state with my RA due to not having the prednisone. Any thoughts?
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Answers (2)
Lene Andersen, Health Guide
7/17/13 1:45pm

I think it's really important that you hook up your ophthalmologist and your rheumatologist, so they can coordinate treatment. RA can have eye complications, so it is in general, it's really good idea to get checked by an ophthalmologist on a regular basis.

 

In terms of tapering off Prednisone, you have the option of going even slower than you are now. Instead of going from 10 mg to 5 mg, try tapering by 2.5 mg every other day. I.e., Day 1 you take 10 mg, Day 2 you take 7.5 and alternate until you're comfortable. Then move to 7.5 mg every day and when you're comfortable with that dose, decrease every other day by another 2.5 mg. Prednisone withdrawal can be really hard, but if you stick with it and supplement with stress relief, meditation and moving as much as you can, you can make it out on the other side feeling better. However, if you still have a lot of problems, please make sure to talk to your rheumatologist for advice.

 

One additional question I have for you is whether you are only on prednisone or if you also take any other medication for RA? Having a lot of problems tapering off prednisone indicates that your RA is not under control. You may want to talk to your rheumatologist about exploring treatment options that can better control your RA, so you won't need prednisone.

 

good luck! Please let us know what happens?

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maryff, Community Member
7/17/13 1:58pm

Lene, thanks so much for your response and suggestions. I am currently on Humira, between three and four months now, having failed Enbrel. In addition to Humira I also take Methotrexate, folic acid, vitamin d, and the dreaded prednisone. My initial symptoms started with pain in my hands, and my left wrist has always been problematic. After recently having an EMG and nerve conduction test in which all results were good, my rheumatologist tells me this ongoing wrist pain is joint pain/damage. I have been in and out of a wrist brace for the bulk of this past year. I hope this can provide you a bit more info as to what is going on.

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Lene Andersen, Health Guide
7/18/13 7:32pm

Is estimated as if it will be a good idea for you to discuss treatment options with your rheumatologist. Your current treatment regimen seems to be having trouble keeping things tamped down.

 

what do you mean by your left wrist being "problematic"? That is, what made you doctors think that it could be related to nerve damage?

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maryff, Community Member
7/19/13 1:01pm

Well, before I was even diagnosed with RA I had tendonitis in left wrist. After I came out of the brace from the initial treatment for the tendonitis I have had long term (just about a year) pain in the left wrist and forearm. I cannot really bear any weight, more than a pound in either arm without pain. I also have fibromyalgia and have been told that I am having persistent nerve pain in my legs. But recently I have been having numbness and tingling in last two fingers of left hand, thats when my rheumy recommended the nerve conduction test, but all results were normal. So I am still having pain in left hand, and the numbness. And in the past couple of weeks the nerve pain has started in both arms. I see my rheumy again in September and hopefully she may have some better ideas, right now she is suggesting increasing my gabapentin and a referral to a neurologist.

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Lene Andersen, Health Guide
7/19/13 3:40pm

I completely agree with most of what your rheumatologist is doing — I do think that a referral to a neurologist would be a good idea.

 

From an experience point of view, though, I have a suggestion. I also, have both RA and fibro and have had the numbness and tingling in my ring and middle finger, as well. It always comes from my neck/shoulder area, and/or elbow. How does your neck/shoulder feel? Really tense? Hurting? Try using muscle relaxants, heat, etc. on your shoulder, especially the trapezoid muscle and see if that helps. As well, ask for referral to a physical therapist and ask for ultrasound on that area. I used to have horrible pain and often numbness and tingling in those fingers and could barely do anything. Then I got ultrasound and felt much better. When it acts up, I also get trigger point injections of lidocaine on its own or a steroid shot mixed with lidocaine in the trigger point on the shoulder on top of the trapezoid muscle. Works a treat, as well.

 

I don't know if any of these techniques would work for you, but it can't hurt to try…

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maryff, Community Member
7/21/13 4:21pm

Thank you very much Lene, I will check them out!

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Lene Andersen, Health Guide
7/21/13 8:52pm

good luck! Please keep us posted on how things go?

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Ruth, Community Member
7/16/13 5:01pm

You did not mention if you are on any medication to treat the RA, are you in conversation with a rheumatologist to treat the RA with methotrexate or any of the biologic meds? 

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maryff, Community Member
7/17/13 9:23am

Ruth, sorry, yes, I am on several meds to treat my RA. Currently I am on Humira that I've been on for three months or so. I am also on Methotrexate and folic acid and a vitamin D supplement, in addition to the prednisone.

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By maryff, Community Member— Last Modified: 05/06/14, First Published: 07/12/13