RA Flare: Has anyone heard of this? | Arthritis Information

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Hi all, I am new to the forum.  I'm just wondering if anyone has ever heard of this.  My mom has rheumatoid arthritis.  She is 58 years old, and up until about a year ago her RA was in remission.  She was doing well and was the picture of health until she was diagnosed with Uterine Cancer in March of 2006.  She had a hysterectomy and 6 rounds of chemo over that summer.  Following each round of chemo she had a shot of Neulasta.  She started having RA pain half way thru the chemo and swears now that the Neulasta caused her RA flare.  She very much regrets having the chemo now, as the RA is really bad.  She is having a difficult time getting it under control and finding a doctor who actually cares.  She is currently taking Prednisone and Plaqneul.  My question for you is whether or not the Neulasta could have actually done this?  I have researched it, but cannot find anything on it.  Is it possible, but rare?  It is very possible?  And if so, shouldn't people with RA be warned of this?  She mentioned this to her chemo dr, but he didn't really say anything about it.  No one seemed to understand that she saw the chemo as optional, and if someone would have agreed this was a distinct possibility, she would have foregone the whole therapy and taken her chances with the Stage 1b UPSC!  Thanks for any help you can offer.

Hi catcrazy - I can't help you with your Neulasta/RA correlation question, but just wanted to say congrats to your Mother for being a uterine cancer survivor. Welcome to AI!

I can't answer your questions about Neulasta and I'm not sure that anyone on the forum can give you an unbiased completely science based answer. These are questions that her rheumatologist and oncologist should be answering.  There may be people on the forum that have first hand knowledge of Neulasta and they can tell you how it affected them.  It's a possiblity that the assault on her body from having uterince cancer, the mental stress and anxiety,  and receiving chemo caused her to have a flare.  Anytime you go through such a life changing and serious health issue there's always a chance of a flare.  That's the nature of RA.  If it were just the chemo drug I don't know, but my hunch is, it was a combination of everything that she went through.  I hope you can find a definitive answer.  Lindy 

When you have rheumatoid arthritis, white blood cells — whose usual job is to attack unwanted invaders, such as bacteria and viruses — move from your bloodstream into your synovium. Here, these blood cells appear to play an important role in causing the synovial membrane to become inflamed (synovitis).

I guess an increased production of white blood cells would cause her to have her RA symptoms to return. Neulasta seems to stimulate production of white blood cells. Which I would think was a bad thing? not sure. Maybe someone else who is more knowledgable will come along and help ya with your question.

Yes!  That is definitely the theory.  Neulasta is used to increase the number of white blood cells to prevent you from getting sick and having to stop chemo.  She feels this shot of neulasta, 6 of them, made her RA come out of remission.  She has asked the cancer dr and the RA dr about this.  No one really seems to know for sure.  Her cancer dr is really nice, but he knows nothing about RA.  He put her on Decadron for the pain, telling her it was a really low dose.  I think it was 25 mg.  She later found out that this is a super strong steroid and that that was actually a high dose.  She got all the bad side effects, moon face, weight gain, excessive hair etc...  When she finally got to meet with the RA dr he had her taper off of that and get on to the Prednisone.  The RA doctor could care less that she was bald, having just finished chemo, was 15 lbs over weight and in a lot of pain.  He seemed to have no sympathy whatsoever.  He didn't even ask her where it hurt.  Anyway, what I'm getting to is that he had nothing to say about the Neulasta.  The cancer dr is basically like "I cured you of cancer, now go home".  The RA dr is like, try this drug, don't call or come back for 4 months".  Fun stuff.  I pray to God that I don't get this horrible disease!

Welcome to the forum. It is great your mother has done so well with the cancer and that has been accomplished. I had open heart surgery in Dec, and even though the 'heart operation' was a success the stress (as pointed out before) and the doc's not wanting to give me RA fighting drugs as my heart surgery had to heal caused the worst flare you can imagine. I was 3 months in terrible pain with little relief from non RA meds. Finally March 1st I was given Prednisone and then later Remicade and mtx (which I had been taking in small quantities before December).

so, sorry I don't know the drug you are talking about, but I do know surgery and the lack of RA drugs can almost ruin you! I'm just getting back to 'normal' and still have stiff fingers, and bad feet that won't respond to these agressive RA drugs.

Good luck sorting all of this out as it gets real complicated. Lynda

Hummm... maybe find another RA dr? I would.

Best of Luck to your mother, and I hope she stays cancer free!

I had 7 days of chemo associated with my stem cell transplant.  It was my experience that the chemo greatly relieved the RA.  I became more mobile.  Most people do experience an absent of RA symptoms with the chemo.

I also had shots, to stimulate stem cells ie white blood cells in my bone marrow as the chemo wiped them out.

I agree with Lindy on it being a combination of things.  Most drugs used today to treat RA are a form of chemo.  She could of been one of those rare people allergic to the chemo which did the opposite and sent her into the flare.

Maybe someone else had different experience. Hope she continues to improve.

LuAnn

PS I would think the surgery and absent of hormones would be the biggest trigger.

stemcell4me39269.8298842593Thanks for everyone's help.  I agree that it could have been a combination of things that caused the RA to flare.  However, it just seems to make sense the way the drug Neulasta works, that it would cause a flare.  The chemo that she had was actually Carboplatin, which she tolerated quite well.  The problem always occurred after the Neulasta shot.  Now it is a flare that won't stop.  She has terrible pain just about everywhere on her body, especially her knees.  She went to her regular dr for some pain relief as the RA dr is out of town.  He prescribed 1/2 a Darvocet.  She was so mad when she found out he had written down for her to cut it in half!  He obviously had no idea how much PAIN she was talking about!  The Darvocet doesn't work very well by the way.  She had another drug for pain a while back, but it caused her to have shakey hands and neuropathy in her feet.  She takes Tylenol everyday.  Yes, she is looking for a new RA dr.  She will have to drive out of town to find another.  She says her next step will have to be Methotrexate.  I sure hope it works.

Dear Catcracy, Well what a terrible experience from doctors. The cancer doctor sounded like my heart doctor (didn't understand a thing about RA)!!, and your RA doc doesn't seem like the best either. The American health system really is horrible some times!! I understand perfectly how frustrated you must feel. They may be protecting each other by not wanting to admit the 'cancer drug' was responsible for your mother's pain and suffering, now , and not wanting to take responsibility!!. I found the heart doc, my gp, my RA doctor only talked to each other if I MADE them!! I would demand that the RA doc consult with the heart doctor to see when I could be treated with RA drugs. My gp just did nothing.

I hope you can work this out and what a good daughter to help your mother so much. Family understanding and listening to us who have this disease is very important! Lynda

I was just thinking the same thing Lynda. Her Mother is so fortunate to have such a caring daughter serving also as her patient advocate.I just wish there was more that I could do.  I'm going to print out some info for her to read before she goes to the new RA dr. next week.

My younger sister, is fighting breast cancer right now. Like your mother, she too is going through chemo and one of her medications is Neulasta injections. She called me up about a month ago thinking she too might have RA because of the pain and swelling in her joints.  Her OC doc told her that one of the side effects of the Neulasta is bone pain/ joint swelling, the other cause is that the chemo is putting into menopause (my sister is only 37) and that can cause joint pain too.  I don't know if this is any help.... I send prayers to your Mom, I know how tough it is to fight the fight... it makes me grateful everyday I only have RA

BIG HUGS!!!!

 

(((hugs)) and welcome to the board.  Congratulations to your mom for being a uterine cancer survivor!  I am so sorry to hear that now her RA is giving her problems.  I hope that she can get that under control soon and she feels better.  Is it possible to find a new RA doc for your mom? 

You are a wonderful caring and loving daughter.  I can only hope my girls will treat me as well when they get older!

Post edited for this info:  As I was out doinf research on neulasta and the possible RA connection I found that Neulasta and Enbrel are manufactured by the same company. 

grammaskittles39270.3052777778Thank you to everyone for your help.  I have mentioned the stress and chemo, but she remains quite certain that the Neulasta cased the relapse or flare because of the timing.  It is true that the main side effect of the Neulasta is bone pain, achie-ness.  However, she has been done with chemo since last Sept.  I'm just hoping that by getting the word out there that this can happen to people with RA, active or not, that other people might be able to avoid this.  I have read that some people only give the Neulasta shot if your white blood cell count is low.  The Cancer place my mom went do does it routinely after every chemo, needed or not.  I think that policy should be rethought for people with RA.  My understanding is that with RA you have an overproduction of white blood cells anyway, and as a result my mom says she never gets sick!  She never even gets colds, and she's around kids and other people all the time.  Anyway, just a thought.  There must be someone else in the world that has experienced this.  Sparky, good luck and prayers to your sister who is fighting breast cancer.  I am only 38 and couldn't even imagine having to go thru cancer treatment and menopause at my age.  Do you know if your sister is RA/sero positive?  I sure hope not, or she may end up in the same boat.Hi, you are really thoughtful to be thinking of other people when you are going through this for your mother. You sound like a dear person. sometimes we can't figure our which problem is related directly to RA (because our immune system is compromised) we are especially susceptable to infections, so that's always a problem for us, also it is hard for us to get rid of the infections. We can't take our meds for the RA until we are infection free. It sometimes causes us long periods of pain without the proper meds. Prednisone had helped me a lot but please read the negative aspects of this drug in  'Wikipedia' which is a good overall source of info for most drugs. This forum pretty much deals with RA, so maybe a 'cancer' forum would have more info about that particular situation your Mom went through. Frustrating I know, but she will get better after the RA meds work for her and you can find a doctor you Trust! My thoughts are with you. Please let us know. Lynda 
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