Just curious if anyone else thinks that the risk of using low dose methotrexate and cirrhosis is hyped up if you don't have the predisposing risk factors: obesity, hep B or C, or alcoholism. Here are some stats for you to ponder. 1 patient out of 931 seems pretty low to me and there may have been other pre-disposing factors. Wonder what the percentage of cirrhosis is in the normal population.
RA: In RA, first use of methotrexate and duration of therapy have been reported as risk factors for hepatotoxicity; other risk factors similar to those observed in psoriasis may be present in RA but have not been confirmed to date. Persistent abnormalities in liver function tests may precede appearance of fibrosis or cirrhosis in this population. There is a combined reported experience in 217 RA patients with liver biopsies both before and during treatment (after a cumulative dose of at least 1.5 g) and in 714 patients with a biopsy only during treatment. There are 64 (7%) cases of fibrosis and 1 (0.1%) case of cirrhosis. Of the 64 cases of fibrosis, 60 were deemed mild. The reticulin stain is more sensitive for early fibrosis and its use may increase these figures. It is unknown whether even longer use will increase these risks.
Methotrexate can cause major liver problems. IT depends on the type of body you have and how much you can handle. Some people use very little, some use a lot and each come out with or without liver problems.
It will mainly depend on your body.
The good thing about liver problems with methotrexate, arava etc. is that you get tested often for any sign of problems, when you do have them (you may not), you then stop the medication while your liver heals and you can start up again or use another drug.
With the testing they do for these drugs, you will almost catch it 100% of the time before real damage is done. That is why you have so many dr. appts a year to check for liver troubles.
There is an extremely low number of toxicity patients for mtx. These patients have a reverse reaction where they can have swelling of lungs, heart etc. as well as mustles throughout the body. The number is very small, but can happen. I was one of those low numbers that did get the toxicity and had a very long questionaire talk with the people at methotrexate and they told me I wasn't alone in the toxicity.
So, even though numbers are low, always watch yourself to make sure that you aren't one of the chosen few. I thought that numbers were too low to worry about, then i got sick.
Hmmm.....when I think of the word "hype" I think that a big deal is being made over nothing much. I understand the it's against the odds that I'll have liver toxicity due to methotrexate, but I'm glad my RD takes the precaution of having me get my blood checked for it.bubba, just curious how much mtx you were taking and for how long, also was your condition reversible?Just wondering are there any symptoms to look out for if you are starting to have liver problems?
George
George, usually by the time you notice jaundice there's considerable damage done. It's repairable for the most part, but then there's the odd case that isn't. There really aren't any outward symptoms of liver issues until jaundice sets in. Some RDs order liver functions monthly, mine orders them every 2 months. George - I am on a 2-week washout from MTX and antibiotics because of sudden high liver enzymes, and had no symptoms except pale stools. I called a few weeks before my standing two-month blood work which caught this and asked if pale stools could be caused from the medication, and both my rheumy and primary answered no. I cannot wait to see them both again and re-ask the question. There is no sense to any of this, so hang in there ~~ Cathy Edit for PS - I am a 17-year recovering alcoholic, who pickled herself, I am not surprised my liver finally said WHOA ...Thanks!!!!!
George
I think you are all missing the point. ALL medications need to be lookedI didn't miss any point.....I answered the topic question. I think that most of the people on the forum are well informed about their meds. There are always the odd health issue with any med and you take a chance when you take some of these meds.
Most of us aren't capable of living a normal life without dmards, steroids, and biologics. If I thought for a moment that I could function on a day to day basis I would give all of them up. Unfortunately, I'm not one of the lucky ones who can't function without the dmards and biologics. I wish I were. Lindy
Lori, you certainly didn't offend me and I do agree with you. I lost weight so I was able to cut out one of my BP meds. and stabilized my blood sugar before I had a diagnosis or needed to start meds. I've never needed an anti-depressent. I'm on about 1/2 of the Rxs that I was on a year ago, between my internist, RD, and myself we decided that I didn't need some of them. Sometimes we take drugs out of pure habit. Pred. I've tapered to 5.5 mgs and can't go any lower due to adrenal insuffiency. I'm the perfect example that you can drop meds with medical supervision. I no longer take Celebrex. I do take Vicodin but I'm going to talk to my internist about another pain med, probably Oxy. So far the liver is ok, not wonderful, just ok. I just counted the meds I've dropped in the last year and it's 5. I really hadn't thought about it, I just talked to my docs and did it. That's a 1/2 of the meds that I take....damn, I'm impressed.
I know about the pill happy society, I worked for an endocrinologist for several years. I couldn't believe the amount of medications that some patients took. It's so much easier for a doctor to prescribe a pill, than to truly try and treat the disease or the cause, to counsel, to help the patient with diet and to monitor them. I know that naturopathic docs do all of that but many insurance plans don't cover their services. It's much easier to prescribe a pill. We want instant gratification. I think that's why it's so hard on us to wait for the RA meds to kick in. Lori, I think we hijacked the thread....we're sorry! Lindy
I call it the 'magic little pill' mindset. If I just take X, I'll 1) lose weight 2) be happier or 3) have the life I want to live - just like in the commercials. Remember, I'm the best example of this on the planet.
Jaundice is not the first sign of liver damage - for most people, itching is. It's not hives, just itching. I noticed it when my liver enzymes were up and also when starting AP (high LFT at the time). Hence my total belief in the Whole Lemon drink because it cut that maddening itch.
And, not trying to be mean, but I don't think most people on any board have any idea about the meds they take. Not the side effect profiles, not the long term effects, nothing. There's a reason I keep nattering on about my 'cure' - I want off everything - even my benign Minocin.
Hugs,
Pip
P.S. Those of us on Proton Pump Inhibitors do not regenerate our livers. If liver tests are up - GET OFF THE Proton Pump INHIBITOR's.
Pip
Quote: "And, not trying to be mean, but I don't think most people on any board have any idea about the meds they take. "Not the side effect profiles, not the long term effects, nothing" Pip
I feel there are some very well informed individuals on this board who understand the side effect profiles, who question their physicians about long term effects, and understand what the med. will do to them. There are others who don't investigate their meds. and don't question their doctors and they're perfectly happy in not knowing. For the most part I think we're a pretty well informed lot and we do the research on our own, talk to our doctors, and question one another. The forum is here to educate people about their disease and meds. I would hate to think that no one has learned anything from the forum. I know I've learned a lot. Lindy
When I was first advised by an RD (not the one I see now) to take MTX I said no way. He explained that it was a cancer drug, some of the side affects and so on and I wanted nothing to do with such a powerful drug. Further on down the road when I came to realize that what I had wasn't going to just go away, that if I wanted to walk again and live a normal life I was going to have to turn to drugs like MTX. So what's the difference? I know what I know about it and I'm still taking it. I know what I know and I'm still doing what I don't want to do, doing what scares me to some degree about the long term affects.
I'm not saying people shouldn't be informed. I certainly choose to be. But in the long run it's changed nothing.
My bad, Lin, but it's really something I've been thinking. Yes, we're pretty special here on AI and there is a lot of interest in learning...but if I hear one more time that people should be a 'good little patient" or "I listen to my doctor because he has my best interests at heart" I'm going to scream. It's like being in "Moonstruck" and wanting to slap somebody and yell "Snap out of it!" Not so much here - but some other boards are bizarrely vested in the medical establishment. Like they cannot fathom a possibility of a world where they make their own medical decisions. Or where others make their own medical decisions.
I used to think I was a medical error magnet. Since coming here I've learned that very few people actually have good doctors. The 'good doctor' thread didn't have many responses - and some of those said they only had good doctors after leaving a bonehead of two.
I hope this makes more sense.
Pip
Pip, I do totally agree that people should know what they're putting in their bodies. One of the things I like about my RD is that he doesn't just tell me what to do. He always discusses my options with me, answers my questions, advises me what he thinks the best choice and then I decide. I almost always follow his advice because I'm not a doctor. I don't know everything he knows, I don't have the experience he has. I don't think I'm foolish about it but really, I need to have someone who knows more than I do who I can trust. Otherwise he's just a guy that can write scripts and I'm on my own figuring out a disease I've only just come to have and figuring out the way to treat it.
When i was on it, it was about a 6months ago and a trial a year before that. I am not sure what dose it was, after trying medication after medication, i no longer remember what mg were of what drug.
I do know, i was on my first week when it all started, and that they said it was a normal starting dose.
They tried it twice on me and happened both times.
It is over hyped. As long as you have the blood tests to monitor you, it isPPI was one of the drugs that I stopped. I quit taking Celebrex and tapered to 5.5 mg. of Pred. so I felt there wasn't any reason to take a PPI. Really, not much difference. I pop a Tums now and then. Right now I only take drugs for RA/PA/OA, mild hypertension, and hypothyroidism and that totals 8 prescriptions, if you count the dmards and biologics. Mucho better than last year.
It would be a good thing for each of us to review our med list once a year. Like me, you may be taking a prescription drug out of habit. There may be drugs that you don't need any longer. Start 2008 off by reviewing your medication list with your primary physician and your RD. It could save you money and save your health. Lindy
I guess I have not heard any of this about the PPI's. I'm going to read up onLove the idea of yearly checking our meds to see if we don't need some of them.
Lorster -
Here's a different link as I can't find the first one I saw -
http://www.medpagetoday.com/MeetingCoverage/AASLDMeeting/tb/ 7233
And if I'm reading this right, those of us with osteo shouldn't be on these either.
http://www.medicalnewstoday.com/articles/59800.php
Plus -
http://www.sciencedaily.com/releases/2006/04/060414013606.ht m
Pip