An RA Beginner's Guide: How to Manage Medication Side Effects

Patient Expert

This post is the first in a series of Beginner's Guide to Rheumatoid Arthritis by Lene Andersen. Have a topic you'd like to see covered? Leave it in a comment

The average person farts about 14 times a day. If you are on a medication for RA, you can probably double that.

Drugs that help control the disease usually have side effects, many involving bodily functions and fluids not normally spoken of in polite society. But if the choice is between being in so much pain you can't move or higher-than-average flatulence, there really is no choice, is there? So you find a way to manage it and in the process, learn to be a lot less self-conscious.

There are two kinds of side effects: the ones you live with (covered in this post) and the ones where you need to make an appointment with your doctor. If you listen to your body and trust its messages, you will know the difference. When in doubt, see your doctor.

Sinus Infections
Many immunosuppressant meds (e.g., methotrexate and the biologic drugs), make you more susceptible to sinus infections. It starts with the snot production of a two-year-old with a head cold, followed by inflammation (which prevents drainage) and, before you know it, there is a festering stew of nastiness. Taking antibiotics every couple of months is not healthy, but there are things you can do that may decrease the number of infections:

  • Drink lots of water (which dilutes the mucus, making it easier to drain).
  • Eat as much garlic as you -- and the people around you -- can handle (garlic has antibacterial effects).
  • Drink pineapple juice. Drinking the good stuff, 100% pineapple juice, every day may also help. Not only is it full of vitamin C, pineapple contains an anti-inflammatory enzyme.
  • Irrigate your sinuses with salt water. It can be helpful. You can either drip salt water into your nostrils with a Q-tip, like you do for a baby with a cold, or try a Neti pot (see this article on HealthCentral's allergy site).

Medications for RA are notoriously hard on the stomach, causing nausea and acidity and many of us need prescription medication like Pantoloc or Nexium. Further help and management of gas production can be found in over-the-counter medications like antacids (e.g., Maalox or Gaviscon) and anti-gas tablets like Gas-X and Beano.
Ginger and peppermint teas help control the nausea as well as drinking cups of hot water with a small slice of lemon throughout the day, which helps settle your stomach.

When you're nauseated, fresh, raw vegetables and fruit are often easier to get than rich, spicy and/or hot food. Eating lightly every 3-4 hours will ensure that your stomach has something to "work with," which helps keep the nausea down. When it's really bad, toast, dry crackers and other bland foods can help until you feel food enough to eat real food.

Diarrhea and Constipation
RA meds can also cause either diarrhea or, most often, constipation. My naturopath suggested taking acidophilus (a helpful bacteria) supplements once or twice a day with meals to regulate bowel. After I started taking this, I discovered that it also helped combat the acid in my stomach, so I take it religiously. Although acidophilus is probably available in your local supermarket or pharmacy, you may want to get the really good stuff at a health food or vitamin store. Remember to keep it refrigerated.

Constipation can be managed by increasing the amount of fiber in your diet, but remember to drink a lot of water, as well -- fiber needs water to work. Pick up good, grainy bread, snack on dry bran flakes or prunes (surprisingly, quite yummy), granola, trail mix or other high fiber snacks, including raw fruit and vegetables. Plums and cherries are particularly good at getting things moving.

Instead of mayonnaise on your sandwich, hummus, a chickpea-based dip that comes in many delicious flavors, can help add fiber to your diet (it's also much healthier than mayonnaise). Stay away from constipating foods and drinks such as white rice, blueberries, salted snacks, sugar, beef and coffee. Over time, you'll discover for yourself what you can and cannot eat.

If you suffer from diarrhea, on the other hand, eat a lot of white rice, beef, etc. If your diarrhea is severe, speak to your doctor about trying another medication to prevent dehydration, loss of nutrients and weakness.

To maintain bladder health and cut your risk of bladder infections, drink real cranberry juice (not blends or cocktails). You can find bottles of concentrated juice to mix with water in health food stores and many supermarkets.

Dry Skin, Mouth and Eyes and More
Dryness everywhere can also be caused by RA meds -- sometimes, it feels like your body is as dry as the Sahara. Find a good moisturizer (Aveeno is very good) and drink lots of water, which will both your skin and dryness of the mouth. Dryness in your eyes will be solved by using artificial tears several times a day.

If you are a woman and have vaginal dryness, you can use a lubricant, such as K-Y Jelly, when you have sex.

Fatigue and "Fuzzy Brains"
It's quite common to be tired after taking disease-modifying drugs like methotrexate, Enbrel and Humira. Try to arrange your schedule so there's less activity in the days when you know you'll be tired, take a nap when you can and delegate household tasks to other members of the family.

As well, your brain can get fuzzy -- I haven't seen many people talk about it, but when they do, they feel horribly embarrassed. I used to have a memory like a steeltrap, now it's more like a steel sieve -- you learn to find a sense of humor about it. Toni Hurst wrote a very helpful article on how to manage memory issues on HealthCentral's menopause site.

Avoiding Germs Many people are nervous about the idea of a suppressed immune system, but it's quite possible to live fairly normally. It's a good idea to avoid people in the contagious stages of disease whenever possible -- your family and friends will understand when you explain the consequences being sick have for you. Frequent hand washing is a good idea and you may want to carry a small bottle of hand sanitizer.

Overwhelmed Yet?
Seeing it all in print like that can be enough to make you want to stick your head in the sand. Don't worry. just as with your RA, the goal is to manage the symptoms well enough that you can focus on what's important. After a bit of trial and error, managing your medication side effects will become second nature.