MTX and Anemia | Arthritis Information

I had a doctor's appointment today. I still have prominent swelling in only one joint (right wrist), pain is mostly controlled by an NSAID. Have been on MTX now for 3 months, and it has done nothing. Was on 10, then on 15. Now RD wants me to go up to 20 mg, and see him in 2 months to see if I have any change. He was disappointed in the fact that I still have such inflammation present, and (especially with just one joint) he really thinks things should be improving by now. He may send me up to Vanderbilt again if things don't change

I have also developed anemia, that is getting worse with each blood draw. I got a call from the doctor's office two weeks ago, and have started getting serious about my iron.

HOWEVER, if it were caused by MTX, apparently my platelets would drop first, then white blood cell count, then red blood cells. And only my red blood cell count is low.

So it is either:

1. Iron deficiency anemia that can be corrected with supplements

2. Iron deficiency anemia that is being caused by a GI bleed

3. B-12/pernicious anemia (can be corrected with shots)

4. remote chance of folic acid issue

RD really doesn't think MTX is the issue. I am VERY worried that the NSAID I am taking (max dose, every day) is causing GI bleeding. I take Aciphex, but would that help with lower GI bleeds? Anyway, I may have to have a colonoscopy.

I'd seriously be less worried if i had to go off MTX, because Mobic is the only thing that makes my inflammation and pain tolerable. I am ready to make a shrine to NSAIDs, right next to my shrines to Uristat and epidurals!

Will get results in a few days. If it's iron deficient anemia, they will probably have me continue on iron for a month before they check again to see how things are. I am having more and more moments recently where I get faint from moving too fast, so I'm worried it's still getting worse.

I wasn't anemic even in December. I started my cycles and Mobic at the same time, in February. So either could be the cause. Hopefully just cycles.

If they suspect the NSAIDS are causing a GI bleed why are they continuing to let you use them? Especailly at the max dose. That can be serious and serious quick. My dad works with someone that was taking aleve and had horrible stomach pains while driving and had to pull over and call 911. Turns out it had burned a whole in his stomach and he almost died on the side of the road. He never even knew there was a problem.

Take it seriously. I'm a big IUB fan; but it scares me after hearing that story. The max dose every day is a lot. Maybe you have a problem with that one wrist that is causing that particular joint to swell. RA wouldn't be isolated to just one joint on one hand would it? That's a question....I'm honetly not sure.

How much nsaid do you take daily? And what is your diet like, your dietary intake of iron?

Thank you for your concern--this is something I need to think about seriously.

Well he didn't specifically say what he thought was causing the GI bleed, and I only discussed it briefly with him at the end of the visit. I asked if I should continue Mobic, and he said yes. I made sure to mention that (most unfortunately) I was on Vioxx and Celebrex back around 2000 for inflammation in my feet, and I switched from one to the other because of stomach issues. Then one day (after I had moved and was not actively seeing a rheumy) I saw blood in my stool and stopped taking them that day. I had stopped running so the pain was less bad, so I never saw a doctor to follow up. So I have that history. I am on Aciphex now, but I have this inkling that maybe it only protects your stomach from bleeding, and not your intestines.

RD also hinted that I may have some other sort of gastrointestinal problem, and I worry about a mass/cyst/polyp type issue. My grandfather died of colon cancer but of course I am young to worry too much. I have suffered from REALLY bad constipation these past few years that is just unrelenting, and he is worried that may (?) be connected as well.

It will be BAD if I have to stop NSAIDs because before I was on them, I couldn't write and could only type with one hand. In my profession, that is a huge issue. I can dictate, etc. but still, not being able to jot something down is huge. Maybe I can become left-handed? Argh!

I take 15 mg of Meloxicam every day. I guess it isn't considered a COX-2 in the US, even though it is in Europe? Or something like that.

Oh, also about the RA being in just one joint...that is why I was sent to Vanderbilt initially. My local RD was puzzled and thought it might be septic. I'd had an MRI showing tons of synovial fluid, classic RA look, but not enough for him to dx. So he sent me up to Vandy, and I saw an RD who used to be the president of the ACR.

He said it looks exactly like RA, and that's how it should be treated. It may actually be psoriatic, AS, or something, but the type of swelling is all the same, the treatment is the same. It is super rare that I don't have it in my other joints, but he said ignore that, go on MTX before there is more damage. I had a steroid shot before this that my local RD thought should clear it up, being one joint and all, but it didn't clear up all the inflammation, and lasted less than a week.

My left ankle has visible swelling, it looks like I have an extra bone and I get a red spot right over the swelling. It doesn't hurt except to the touch, if you push on it. RD isn't focused on that right now. My fingers also have some RA. Before I was on NSAID's, I couldn't make a fist. Again, though, just right hand. And my hips sporadically cause lots of pain (inner thigh/groin) but that comes and goes. Also, I had a bout of costo. So I have other joints involved, just not as badly as my wrist.

Joie, I used to be a vegetarian but fell off the wagon after my last pregnancy. But I still don't eat a lot of red meat. So I had a big spinach salad at lunch today! With bacon! :)

KatieG2008-06-04 12:55:23Just bumping this to complain here, rather than starting a new post. I was feeling awful on Monday and Tuesday, then started my cycle yesterday. This morning, I had horrible abdominal pain (gas pain I'm almost positive, which is always worse during my cycles). Couldn't bear the pain, got up to close my office door, decided to go to the bathroom instead, almost fainted on the way there, then almost threw up until I put my head between my knees. Just waiting for call from RD about bloodwork. If it is not anemia, something is up.

I suspect either GI bleeding or maybe fibroids? My mom had them when she was my age. She didn't have a hysterectomy, I think they just monitored them, but I'll have to talk to her about that more. Or else I'm just super anemic by nature with cycles.

Trying to get as much work done as possible...not a good day...