I have been on Naproxen 500 mg twice a day & Methotrexate 15 mg/week for about a month. My history is 2 episodes of iritis in the last year, HLA B27 positive, and peripheral arthritis with some pretty severe lower back pain. My rheumatologist put me on the Naproxen & Methotrexate to of course prevent future iritis as well as treat what he originally thought was reactive arthritis. But after looking at my x rays, he is now thinking that perhaps I have Ankylosing Spondylitis (I had an MRI last Fri. of my SI joints, so we'll see). Based on those results, he may be changing me to Humira or Enbrel in the future. All this is just background to my question .
He (my rheum.) is changing practices - and I won't have access to him at all until I see him in his new practice end of Sept. My question: over the last 3 days or so I've developed really bad heartburn I believe is related to the Naproxen. Some websites say to discontinue use - some say this is a common side effect & do not discontinue. Do you (Mike) or anyone have experience with this side effect? Is it dangerous? I am scared to stop the NSAID part of my drug therapy - but the heartburn is so bad it wakes me up at night. Any suggestions? Of course I will ask my dr. when I next see him but like I said that's not for a month.
Thanks for any insight,
Jill
(Mike - I know in one of your posts you mentioned you had a granddaughter named Jill or Jillian . She is truly lucky to have such a kind & selfless person for her grandpa!)
Call the prescribing doctor TODAY, ask if another drug would be more appropriate or if a protective med could be added in the Proton Pump Inhibitor class. there is absolutely NO REASON to tolerate this type of thing and the doctor is there to interact with when you need him. if he can't help you now, get another doctor.
you must also remember that the seronegative spondyloarthropathies overlap in symptoms. they can make it difficult to decide what to 'call' something. a close section gallium scan of your lower lumbar region might indicate what is going on but the treatment would be the same.
the MTX could be adding to the GI distress. are you taking folic acid about 11 hours after taking the MTX? don't take it sooner as it can interfere with the way the MTX works but it has to be taken to replace this B vitamin depleted by the MTX.
ENBREL HAS NO USE IN TREATMENT OF UVEITIS, it can even CAUSE UVEITIS to occur in some individuals. should they prescribe Remicade or Humira they can be taken but sometimes the schedule of dosing has to be shortened and MTX is still employed with the uveitis.
the enteropathic arthropathies, crohn's and ulcerative colitis share arthritic symtoms with AS, reactive arthritis etc. crohn's symptoms start at the mouth and go to the other end so to speak so you most likely will require input from a GI specialist to rule out that stuff too.
the goal is off all steroids without inflammation in the eyes. do whatever necessary to achieve this. you will be rewarded with healthy eyes. I do hope you will not require TNF A blocking drugs such as Remicade or Humira. they can have serious side effects not found withe the DMARD class of drugs for treatment of uveitis. often the amount of MTX is more than the rheumatologist is used to prescribing. when it reaches about 25 then switch to the injectible form of MTX which would half the amount needed to get the job done and side effects would also be lessened.
Remember, don't take enbrel for uveitis. get a prescription for a proton pump inhibitor to help with the GI distress. Zofran is expensive but it works for the GI problems associated with MTX and NSAIDs.
Dolobid, Difusinal is a generic NSAID that also works and is inexpensive. it still has Gi upset etc possible with it. your doctor needs to check other organs besides liver and kidney function as meds can cause heart stuff to occur. you might ask to be tested for severe dry eyes too. many with HLA B27 uveitis end up with this and it can compromise the cornea and the sclera by causing abrasion between the eyelids with too thick of lubricant secretion acting like sandpaper and then the cornea or sclera become infected resulting in serious problems such as opacification of the cornea and scleral ulceration/necrtizing scleritis etc.
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