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I have infamitory artritis or Rheumatoid artritis depending on which Dr. I go to. I have lost a lot of strenght in my hands and my legs and a lot of mass in my legs and hips. I also seem to be getting really tired a lot of day. are these simptoms from the artritis? What can I do to keep from loosing any more strenght? And from getting so tired.

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Female , Age: 63

Already Tried:
I'm on predisone for asthma and the rheumatologist will not try anything else at this time. I was on Katoprofen but and had been for 15 years but started having trouble with the asthma when taking it also had trouble with asprin 81mg. had to stop both. I do take pain meds. and I have austioporosis which i take fosmax and calcium for

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Hi--couple Q's:

-Usually, LAB tests can differentiate from Rheumatoid vs. Inflammatory (or Osteo-) arthritis (like RF; ANA; ESR)...have you had these done?...results?

Once you've answered these questions with clear, well-thought out answers, I will reply with my Expert Medical Opinion. Your answers will enable me to get closer to an accurate diagnosis, which is critical to obtaining successful treatment or cure.

Thanks, --Dr. Steve, Your Online Family Doctor

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Reply to Dr. Steve's Post: I do test positive for RHeumatoid factor but some of the test are affected because of the predisone.
I'm busy thank goodness with our bussiness. My husband is a writer and I send out his stories to publications around the country (Antique & Collectible). We do have a good relationship and have been married for 45 years. He is very understanding and helps me as much as I will let him. I was a QMA for 25 years but I'm on disability now.

Hi

How much prednisolone are you on?

I suspect many of your symptoms are due to your prednisolone - especially your muscle loss?

Is your rheumatologist not willing to prescribe a DMR?

AI

Reply to Alexander Irvine's Post: I have been on predisone for most of my life off and on I'm on 20 mg. not and I do not gain wt. on it.My mantaince does is 10mg. and my allergest wants me to stay on this does for at lest 2 more months before I try to cut down again. I was on 40 mg.

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Hi--thanks for reply.

Based on the info, I believe you have a Combination of Rheumatoid AND Osteo (Inflamm) -arthritis (many patients have such overlap). While the treatment regimen has been reasonable, I do agree w/ you that newer treatments should be considered. I suggest you get a second opinion from a different (hopefully, more recently trained) Rheumatologist. I say this because I know that a number of NEW (improved) medicines for Arthritis (esp. RA) have been FDA-approved within last several years.

Hope this helps...Best Wishes,

--Dr. Steve

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1 Other Expert Agrees with this!

Reply to Dr. Steve's Post: I will not be off the steroids because of my asthma.

That is unfortnate.

What else are you on for your asthma?

AI

Reply to Alexander Irvine's Post: Two inhalors,
A steroid and Alupent
I feel worste every time I cut down my predisone.
The alergest said they don't give me any thing for the other problems Like the arthritis, asthma, and renal insaficiancy, yes I do have type 2 diabities this year.
What I want to know is does the Arthritis cause the loose of strenght and tiredness

YES--chronic, progressive arthritis CAN cause weakness & tiredness; BUT, so can long-term prednisone (steroid) therapy. It may be hard to distinguish which is the cause; except by stopping the pred for a while and seeing if symptoms change.

--Dr. Steve

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Hi

There are signifiacnt other meds you can take for your asthma

Alupent is a relly old fashioned treatment - I've not had a patient on that for years!

Are you not on an inhaled steroid?
I'm not surprised you have become diabetic.
Oral steroids are drugs of last resort for asthma.

I'll post you a link that outlines modern asthma management.

http://www.patient.co.uk/showdoc/40000622/

Short acting B2 agonists are meds like salbutamol
Long acting B2 agonists - salmeterol, fomoterol
Leukotriene antagonists - singulair ( montelukastat).

AI

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Reply to Dr. Steve's Post: At 8 mg of predison I'm in trouble with my breathing. The last time I tried less then ten mg. Was on Methatrexat and folic acid? but he took me off it sence I couldn't get off the predisone.

Reply to Alexander Irvine's Post: I am on an inhaled steroid and I had trouble with albuteral and switched to alupent also have a nose sprey. I used to take an asthma medication but they stopped it when I went on voltaren. and no one has put me back on anythin also took theodur for years with the seroids.

Hi

Can you tell me ALL your meds!

AI

Reply to Alexander Irvine's Post: Flowvent 220 mcg. 2 puffs bid
Alupent 2 puffs prn
Predisone (10 mg. qd. Maintenance ) now on 20 mg.
Benadril 25 mg prn & 2 hs.
Doxycycl HYC tab 100 mg. 1qd   (just finishing a round of Avelox 400 mg 1 qd for sinus infection)
Diflucan 100 mg. 1qd
Zantac 150 mg. 1 Bid
Premarin 0.9mg. qd first 25 days off 3 or 4 days.
Fosamax 70 mg. 1 q week
calcium Bare foot then Oyster shell then eat dairy
Lasix 40 mg. Bid
K-Dur 20meq 1 Bid
Antivert 25 mg. 1 tid. I’m taking 1 bid and ½ at noon

Prn
Hydrocodone/apap 7.5/500 q3hours (Maintenance dose is 5/500 bid (7am and 1pm) and 7.5/500 hs).
Magnesium
Simethicone 180 mg for gas.

For breathing machine 2 to 4 times a day.
Have Alupent

Hospital for asthma in 1968? (added wing on to nursing home then redid the rest of the nursing home)
Hip replacement 9-11-01 Methodist hospital Dr. Pierson.
Fractured pelvis Jan 02
Hysterectomy July 1978
Tubal in the 68?
Lump from breast in 1966
Fractured bone in left foot February 2005
Fractured bone in right foot discovered on x-ray June of 2005 healing
Fractured ribs left side October 23,2005 re-injured
Spider bit Nov. 28, 2005   Dr. 12-5-05 finally left July 15, 2006.
Added Diabetic & Renal Insufficiency to diagnoses in Jan. 2006
Left foot stress fracture beginning Apr. 11, 2006
Asteroid Hxalosis-right eye

Wow.

I see your steoids have also caused osteoperosis.

And fungal infections......

How is your mood at present?

AI

Reply to Alexander Irvine's Post: I'm ok if I'm not in too much pain. The hip was from a vascular necrosis. But all the problems from the steroids beats not breathing. I really appriate you time. Decongestants cause me to be depressed if I'm on them over a week or 2 at a time. And I get upset because I can't do some things anymore, but I'm learning to ask for help. Also I have exzena undercontrol now but was really bad untill I found valisone cream when i was 28, then my hands were still bad untill we got a dishwasher.

Hi

My time is not a problem.

I think your situation is a trade off between your asthma and side effects of your steroids.

As long as you are on them any inflammatory arthritis as well as your asthma will remain in check - but you do need to accept the consequences - muscle weakness, low mood, diabetes , osteoperosis , hypertension, stomach ulcers ets.

Where is most of your pain - is your sleep disturbed?

AI

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Reply to Alexander Irvine's Post: my sleep is disturbed if I don't take pain meds around 8 pm. I go to sleep but wake up in a hour or so then can't get back to sleep. So I take a pain pill around 8 pm.
At the present my right ankle and elbow are painful also my back but I keep on going like the energizer bunny. My hands are sore the lower joints and I drop things easily. It is hard to pull a fill out of the file cabinit some times and almost imposible to open a cfd coke with out the aid of my wrench like you use to change oil filters it is a life saver. I have lost 2 inches in height.

Hi

You situation is difficult.

Would you consider taking an antidepressant?

Some of these are very helpful for patients with chronic pain especially if they have poor sleep.

Have you hand a bone density scan recently?

AI

Reply to Alexander Irvine's Post: I might consider but need to get my allergies settled down before I try any other meds. I know this sounds crazy but I got a spider bit and it took over 6 months for the place to go a way the doctor thought I had a vein that was involved now you can't find the place. When it left I could start cutting down on the predison and did but still have to be very carful of what I eat and take couldn't even take the calcium for a while this happened once be when my allergies got all messed up.
What really upsets me is that the people on the new med. Remacade etc. are given preisone for flare ups but they wount give me anything for the artritis because I take predisone. So I will probobly get worse and worse. Now I'm not going down without a hell of a fight. I had a patient that came in only able to bare wt. with a piviote and she learned to walk behind her wheelchair and started to do needle work again. I figure if I really work at it and try really hard I can keep going even with out the new meds. I'm not over Wt. only weighted 118 at the Drs. last time. But it just makes me mad that pain med is all they do for me. I'm glad I have the pain med because it enables me to keep moving and I really enjoy helping my husband with his writing books and news service. I just hate having to ask for help I was a care taker having. I also fix lunch for a parapoligic that lives close 2 times a week. I had an aid that worked for me and she had asthma and her dr didn't believe in steroids and she is dead a good 10years younger than I am.
I just needed to get more infor about Rheumatoid Arhritis and see if you had any good idea and to let off some steam. I really do appriciate this.
I have seen 2 different Rheumatologist.

Hi

Good to hear from you.

Would you like some more info on RA and its different treatments?

AI

Reply to Alexander Irvine's Post: Yes and I have a bone scan every year my hip was better but not my spine last Feb. Hope the spine is better this next time. The bone guy said maybe I should also take the nasal spray for calcium. What do you think?

Yes - most definitely - the steroids are very bad for your bone density even with your fosamax.

AI

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