Today was my two month checkup, and things have not been going well for me RA wise this past couple of months. My RD found quite a bit of inflammation in the joints he examined. We talked again in great length about starting Actemra, but he is still hesitant, as my cholesterol level is at 285, and according to him, it can double while on Actemra. Not only that, but a new study shows an increased risk of bowl perforation with Actemra. So as it stands, I will stay on the Simponi every two weeks until I see him in two months. Meanwhile, I will try and work on lowering my cholesterol, and hopefully he'll change his mind about the Actemra when I see him next. My pain level has been hovering around a 8, so he also increased my Prednisone to 15 mg daily. So we shall see.
Another interesting thing he told me today, is that according to a new study, women who take calcium supplements are at increased risk for cardiovascular disease and heart attack. He's taking me off my calcium supplement, and I will try to get at least 1500 mg of calcium from my diet. I did a quick research when I got home, and this is what I found...
http://www.medicinenet.com/script/main/art.asp?articlekey=143393
Anyone else been told this by their RD? Being on the Prednisone and a PPI medication, I'm really kind of nervous about stopping my calcium supplement. It's always something!
Hi Gale, I'm so sorry you didn't get better news. Did you and RD discuss something else you may consider, other than added pred., besides Actemra? I know the whole cholesterol thing with Actemra was why RD encouraged me to nix it when I was looking to switch and we nixed Orencia because I had already had lung issues.
Thanks Waddie! Other than Actemra, we really didn't discuss anything else, as I've tried everything else without much success. The longest I've been on a biologic is 2 years, and that was Orencia. I seem to be one of those that builds up antibodies to the medication, and eventually it stops working.
i guess I'm just going to work on getting my cholesterol down. Like yourself, I really don't want to add any more meds than I'm already taking. My Mom had very high cholesterol, so I may end up on medication regardless. I just feel like I need to give Actemra a try, even though it's risks are somewhat higher than the other biologics I've been on.
I also was shocked when my RD told me about the connection with supplemental calcium and heart disease. Good luck tomorrow with your CD, and please let me know what he says about the supplemental calcium thingy!
Hi Gale, I was taken off calcium this past winter when Orencia and MXT pushed me into heart failure. Was told the same thing, did the research and am hoping that I get enough calcium in my diet. My bone density studies have been fine and osteo isn't an issue on it's own; just the osteo caused by RA inflammation in my knees. Like you I'm between the proverbial wall and hard place with meds. Just started Imuran and will receive my first Rituxan infusion tomorrow. Like you I just have to take Pred. and pain meds until I'm out of this flare from hell and the Rituxan begins to work. I can only tell you to follow a heart healthy diet for your cholesterol lowering process. LindyHi, Lin B~ Just sending a quick note hoping your Rituxan works soon. Best Wishes, VMy RD has also been considering Actemra, but the gi issues are concerning him. He said it was just FDA approved for JRA, but I need to get my gi issues under control. I've been inpatient 4 times since Feb due to gi complcations. He is waiting for the GI dr. to give the all clear. I have eye issues as well. Uveitis is my most frequent issue, and Actemra is supposed to help with the eyes.
To investigate whether calcium supplements increase the risk of cardiovascular events.
Patient level and trial level meta-analyses.
Medline, Embase, and Cochrane Central Register of Controlled Trials (1966-March 2010), reference lists of meta-analyses of calcium supplements, and two clinical trial registries. Initial searches were carried out in November 2007, with electronic database searches repeated in March 2010.
Eligible studies were randomised, placebo controlled trials of calcium supplements (>or=500 mg/day), with 100 or more participants of mean age more than 40 years and study duration more than one year. The lead authors of eligible trials supplied data. Cardiovascular outcomes were obtained from self reports, hospital admissions, and death certificates.
15 trials were eligible for inclusion, five with patient level data (8151 participants, median follow-up 3.6 years, interquartile range 2.7-4.3 years) and 11 with trial level data (11 921 participants, mean duration 4.0 years). In the five studies contributing patient level data, 143 people allocated to calcium had a myocardial infarction compared with 111 allocated to placebo (hazard ratio 1.31, 95% confidence interval 1.02 to 1.67, P=0.035). Non-significant increases occurred in the incidence of stroke (1.20, 0.96 to 1.50, P=0.11), the composite end point of myocardial infarction, stroke, or sudden death (1.18, 1.00 to 1.39, P=0.057), and death (1.09, 0.96 to 1.23, P=0.18). The meta-analysis of trial level data showed similar results: 296 people had a myocardial infarction (166 allocated to calcium, 130 to placebo), with an increased incidence of myocardial infarction in those allocated to calcium (pooled relative risk 1.27, 95% confidence interval 1.01 to 1.59, P=0.038).
Calcium supplements (without coadministered vitamin D) are associated with an increased risk of myocardial infarction. As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population. A reassessment of the role of calcium supplements in the management of osteoporosis is warranted.