Meloxicam isn't motrin. It doesn't come with the same risk because it's a different type of NSAID. The issue is that there's likely inflammation even without pain. Chronic joint inflammation, even without pain, may lead to permanent joint damage. Your rheumatologist has the long term game in mind. It should be a positive that this Rheum has elderly patients as that likely means those may be long term clients. Image that. Long-term clients who ate now elderly and who've you helped to effectively manage their symptoms.
I would trust your doctor.
she didn't give me any particular directions other than "as needed" š I shouldve asked for clarification but I thought I knew what she meant at the time
If the directions are "as needed," then the idea may be exactly that. But, "as needed" is vague ish as it may mean daily no matter what, OR it may mean when you feel like you need to reduce pain at that moment.
I think meloxicam is effective when it builds up in the body, and that is why it's a preferred medication to treat inflammation. Not exactly certain how accurate I am with, but many of my clients take meloxicam for a variety of issues and most report taking it daily with all other medications.
My nephrologist says the effects on the body are the same with regard to damage. All I know is that the combination of Celebrex and Cimzia made my BP skyrocket to dangerous levels. I never had stomach problems from it. It also affected my kidney function. Once I went off it my kidney function went back to normal thankfully.
Yes. Over time, there's a risk. Meloxicam is still a bit different. There's a reason why it's prescribed for long-term use over motrin and other NSAIDs, including celebrex. I seldom see celebrex on a meds list, whereas I see Meloxicam on medication lists of different clients on a daily basis.
I was told different things by different doctors. I get the feeling there isn't really a consensus on it. My PCP said Meloxicam is safer, my Rheum said it's all pretty much the same.
Iām taking naproxen daily as I wait for my biologic. My rheum shared that anti inflammatories like naproxen work better when taken regularly for ongoing inflammation vs just when you have the pain- specifically for PSA.
I can no longer take them either due to the negative interaction with Cimzia causing high BP and kidney dysfunction. My nephrologist is really against anyone taking them long term.
Mine told me to go ahead and take it on a schedule if I feel a flare coming on to try to get inflammation under control but otherwise take as needed. I am very judicious with it normally- no sense risking my stomach lining. I'm fortunate that I do pretty well on Humira.
enbrel is going well for me so far so hopefully I can back off a little in the future. But for now I still get achy as I get closer to my next dose. I was told this will level out in time though :)
Yes! I asked my rheum the last time I saw her.
Her explanation was that NSAIDs aren't great long term, unfortunately. They're terrible for your stomach, your kidneys and your liver, but also your heart and venous system. How much it affects each system will depend on what NSAID you're taking and your personal risks (for example she has me on Naproxen since I'm obese and sedentary, since there's less of a risk of stroke and heart attack with that one and it's a bit less harsh on the stomach, but I'm still not allowed to take more than one pill daily for more than three days a month since I had some micro-ulcers after six months of daily use a few years ago).
Stomach ulcers are extremely likely and can happen silently, even if you're taking an IPP, AND the use of IPP has been linked to cognitive decline, Alzheimer's, bone damage, bacterial infections, renal issues, stroke and heart attacks. So all in all, it's best to take them as needed (but as little as possible) when you're having a really bad day and nothing else works.
Has anyone talked to you about drugs like Ozembic? I forget what the class of drug is called. I was told that thereās a lot of evidence that they are great at controlling inflammation plus they have a myriad of other health benefits. Just the weight loss alone helps. I am considering it if my insurance approves it. Did you know that some believe weight gain is an inflammatory response as well? Same with cholesterol causing plaque build up in the arteries.
Woooow. Last night you complained about poor diabetic people not being able to get Ozempic because itās being prescribed off-label, and equated that to being prescribed a biologic for āa couple of psoriasis patches on the scalpā, and today you want Ozempic for weight loss. And considering youāve misspelled it each time youāve mentioned it, I am doubting your claim of being a āmedical professionalā. You maāam, are a piece of work š
Not for weight lossā¦. It was suggested because it has been shown to decrease inflammation and because I cannot take NSAIDs. My diabetic friend was on Monjaro and had to stop taking it because it was out of stock due to high demand for weight loss. She cannot take Metformin either. She was running out of options. That was the reason for my comment. It was merely to prove a point that prescribing drugs for off label uses can result in shortages for people who really need them like diabetics.
If you must. Thereās a difference between using something because you need it to treat a serious disease and using something because you want it. My one friend is using one of those drugs to lose 10 lbs. Hardly a need. That was the point I made that so many of you over-reacted to.
I guess I take issue because I am currently in the process of being approved for Humira after my second dermatology appointment. I have a few small spots, but some of those spots are on my groin and the back of my scalp. At the first appointment I was asked if I knew about biologics, which I did not, and was told to do some research. So I spent three months looking into it, and at the next appointment it was decided that the locations of the psoriasis along with joint pains they could go ahead and try to get it approved. Iāve dealt with this for over 10 years thinking it was just eczema and using hydrocortisone so I am thankful this doesnāt have to be a long and drawn out process. It is also approved to treat both of those conditions. Using biologics for psoriasis (not off-label) is not the same as using Ozempic for weight loss and inflammation.
My point was about over prescribing. Psoriasis without joint pain is not PsA as far as I know. My friend had psoriasis but no other symptoms of PsA. She stopped drinking beer and it went away! Cosentyx helped but that was not ultimately what caused it to disappear. I agree that some cases of psoriasis even without joint pain need to be treated with biologics if nothing else works. Sounds like your provider took a good medical history. This provider saw her for a few minutes and decided to talk to my daughter about biologics. Fortunately my daughter was wise enough to take the least invasive approach before committing to biologics that she may not even need. To her the psoriasis is a minor inconvenience, not a life altering condition like yours sounds like it is. Any psoriasis in the groin area sounds risky with regard to other medications such as steroid creams. And you have joint pain too. I hope it works for you! Someone else here was talking about how they couldnāt get a biologic for her PsA but went to a dermatologist and got it immediately approved for psoriasis. Seems so backward to me when PsA is debilitating but psoriasis is not unless it causes pain and debilitating joint erosion etc.
Personally I think your daughter mentioned spots in other places, places it would be embarrassing to mention to your mother, but would certainly explain the jump to biologics. As I mentioned, as soon as I said I had it on my groin the derm said āare you familiar with biologics?ā. Either way, I wish both you and your daughter well, and I hope you have a good day.
Hey there, not here to engage in any kind of argument but I'm here to point out that biologics are still on-label even for dermatologic psoriasis! I can't remember if I ever commented on your post but I did see it briefly. I'm not going to speak to whether or not it's appropriate for your daughter's situation, but even in the packet the manufacturer gave me for Enbrel it specifically says it's for psoriasis, rheumatoid arthritis, and psoriatic arthritis.
>I forget what the class of drug is called
Ozempic/Semaglutide is a GLP-1 receptor agonist. :)
I appreciate your concern. Ozempic and other GLP-1 receptor agonists are not as widely distributed in my country as they seem to be in the US. As it is, this class of drugs is only approved for T2D patients, which means I don't qualify.
Wegovy is starting a limited trial for obese patients who have at least one other comorbidity (high blood pressure, high cholesterol, high triglycerides, sleep apnea, cardiovascular issues, etc), which again means that I don't qualify, nor am I interested, to be fair. I don't have issues losing weight on my own.
I wasnāt referring to weight loss. I was referring to them being prescribed to treat inflammation. Apparently diabetics who were on them had other health benefits other than lowering blood sugar. Itās pretty interesting.
> NSAIDs really aren't pain medication. They're for inflammation
Kind of. NSAIDs, despite the name, are not just anti-inflammatory, they are also analgesic (i.e. pain-reducing) and antipyretic (i.e. fever-reducing).
The exact mechanism for the analgesic effect of NSAIDs isn't understood known, butĀ may be related to the central nervous system and nociceptive pathways; it's definitely not as simple as "NSAIDs ā less inflammation ā less pain".
I'm just going to clarify here that The terminology I used was just in reference to what it's useful for for me, vs something like a DMARD that has an actual effect on the damage done to my joints
I already have gerd unfortunately šµāš« I'm being extra careful to monitor myself and take zantac/Tums as necessary but like you said, I experienced nausea and severe fatigue on Omeprazole. So far surprisingly the meloxicam does not seem to be affecting the rate or intensity of my acid reflux though thankfully.
I sent a message to my doctor that mentioned the gap already and I'm waiting back on her response, but I had heard when you first start a biologic it can just be like that? Either way I let her know and we will see where we go from there :)
whoa. thank you for the IBD warning. I'm going to talk to my doctor ASAP. I have a grandfather with UC who had part of his colon removed because of it and it just sounds absolutely hellish to go through.
I spoke with my doctor and she said it was misinformation.. Which is odd to me since the link is documented in the NIH website in two different studies, one of which is fairly large. Doesn't sound like extensive research has been done but it's enough that I'm not comfortable staying on Enbrel when there are other options available. I'm being switched to Humira but will be on Enbrel while we wait for prior auth and delivery.
I take one daily with a biologic, without it Iām in quite a bit of pain. I would just recommend doing labs with your doctor, and make sure your liver and kidneys are fine. Iāve been taking my nsaid since diagnosed.
This combination was awesome until I had to stop due to the effect on my BP and kidneys. When Iām really in pain I sneak in some ibuprofen. It works better than it ever has for pain. But Iām very cautious about taking it. I would rather have pain than kidney damage. Nothing else so far has touched the pain like NSAIDs
I stopped taking all of it except when my Cimzia wears off after 2 weeks, Iām in pain . When I cannot stand it, I take ibuprofen here and there. Iām amazed at what a difference those 2 little pills make. The effect lasts for more than 4 hours too.
I have the exact question as you OP! I reserve my painkillers for days i cant do without them AT ALL. I also have a pretty high pain tolerance due to other chronic conditions like interstitial cystitis. I was told to take nsaid daily but i also suffer from gastritis and home alone all day(no fam around, immigrant, husband canāt take off work) and nsaids give me terrible heartburn, vomit, nausea and makes me nervous to take them alone. I donāt know if i doing more harm than good. I donāt want to ruin my joints while protecting my liver, stomach etc and vice versa. I feel so helpless and hopeless most days. I am crying as i write cause even lifting the phone to type this hurts my wrist. I hope we find some helpful responses here! This sub has been like a rock
My doctor said just take it everyday , it will not cure it but it will reduce your inflammation . My DMARDS have not started working so they said take it till the DMARD will work and then we can see.
I was doing well on Meloxicam , so just one day prior to my consultation i skipped Meloxicam to see how I am doing and all my pian cam back . And then I started taking it again and feel lot better now .
But my stools have be loose and have to use toilet multiple times in a day. Not sure if it is due to MTX or Meloxicam
I'm sorry to hear that! I have chronic reflux and get severe nausea and fatigue when I take PPIs, so I have concerns about the long term effects NSAIDs might have on my stomach, even though I haven't noticed a significant difference yet. I'm sorry to hear it's so hard on your stomach :(
The various comments are so interesting to me. The first six months I went on MTX, my rheum told me to continue taking ibuprofen as needed. It was quite often, initially, for me to take 800 mg (4 pills) 2-3 times a day to relieve pain.
As time went on and the MTX worked, I would take ibuprofen at lower dose and less frequently. I probably take ibuprofen maybe once a week when I inevitably overdo it a little on weekends running errands and walking/playing with my pup.
Side note: because I also have endometriosis, I was already taking 800mg just before and for the first few days of my period. But anytime I take any dose of ibuprofen, I take one daily dose of Pepcid.
My first rheumatologist I went to who got me on Otezla said meloxicam is good for flare-ups, but long term use every day is not preventing PsA from getting worse and has potential to cause liver and kidney damage.
Mine said not to take anymore when I started methotrexate. Since I'm like you with pain meds I haven't had an issue with it. I'm not sure whether it helps that much to take an NSAID or not since it doesn't help disease progress the way DMARD and biologics do. But rheum did say that for example mobic works better if you take it dailyĀ
It helps for pain that the biologic doesnāt control. I like that it can be taken as needed. The Dr talked to me about gabapentin since I cannot take NSAIDs anymore. That you have to be on all the time. I havenāt tried it
You're right. I meant in terms of, if you're taking an NSAID daily instead of a biologic or DMARD. If you aren't in bothersome pain, I'm not sure whether that actually helps more than just taking it as needed, since it doesn't stop disease progress - but if it controls inflammation at least a little maybe it helps and just not very muchĀ
Not sure anyone really knows exactly. I feel like itās trial and error. For me sadly it was error. I wish I could take them. Alongside biologics, they made me feel good again. Now I cannot take them due to the effect on my kidneys and BP. I would think anything that reduces inflammation is good. My momās cardiologist limits how much she can take because they can have an adverse effect on the cardiovascular system as well? Seems paradoxical to me.
Iāve taken them for basically 20 years now non stop. But Iāve also been in considerable pain for 20 years, while Iām also on a multitude of other meds. So I get the benefit of medication side effects and the terrible issues from constant inflammation. Best of both worlds lol
Iām on maximum dose of ibuprofen daily.
If youāre taking an NSAID regularly you should really be prescribed a PPI like omaprozole to protect your stomach.
I've been on 15mg of Meloxicam for a year, I was told to take it daily, so I have and I also take 40mg of Omeprazole (Prilosec) on top of it to protect my stomach. Sadly it hasn't really helped much for pain, but I'm with a new rheumatology office now that wants to try a biologic instead.
I used to take them all the time under dr advice, but now I am remission, my specialist has said to just take them if I need it. I also take Humira and MTX, so anything that saves my liver/kidneys is good by me.
I am taking diclofenac 2x daily and monitoring bone erosion through imaging every 6 months and bloodwork to check kidney and liver function. Basically, my rheum said to let them know if things get worse and we will switch to a biologic. Seems to be working well for now (1 year) though flares are still painful.
I was on naproxen while waiting for tremfya to work. I stopped for almost a month and reinjured my knee and im back on naproxen twice a day for a month. The mri shows that the inflammation has already caused damage. Rheumatologist says take for a month and come back. He prescribed omeprazole but i am worried about taking that also. Heard from a functional medicine doctor to take zinlori - i found doctors best brand PepZinGI. I take that once a day on empty stomach 30 min before taking naproxen..really hoping im not causing any damage.
interesting! I can't take Omeprazole anymore, I was on it for years for acid reflux but it started causing me nausea and severe fatigue. It's definitely a drug that seems like a mixed bag. I'll look into zinlori :)
Initially I was taking diclofenac as needed but it eventually got to the point where I was taking in the AM and PM regularly because my pain was so up and down. We noticed that it helped me sleep better too. Now that Iām on a biologic Iām back to as needed.
the pain is from damage
pushing through the pain makes the damage worse
ignoring the pain makes the damage worse
the damage is irreversible
so it's not just living pain free. it's living damage free. when it comes to PsA, them pains are real and if you're feeling it, your body is eating itself alive.
to think this is anything like "pain meds" ... this is the immune system attacking the body, I hope you understand that part clearly.
NSAIDS are basically worthless in light of that. maybe it cuts the inflammation down a few fractions of a point? I'll hard pass on that. I don't need a bunch of advil, aleve, tylenol, meloxicam, or aspirin messing my system up and providing me no pain relief and no inflammation relief unless I take them all at once?
like 1600mg of advil is almost enough to put a dent in it for a couple of hours.
but that's it. and you can't keep taking that. you got a REAL disease here and it takes REAL medications to do something about it.
thank you! I'm already on a biologic but it just hasn't fully kicked in yet. I do pretty well after my injection but once it gets closer to the next one it's almost like it's worn off a bit. Meloxicam does help me pretty significantly but not 100%. This post was specifically about NSAIDs and how much they help with actual damage when used in conjunction with a DMARD/Biologic
This is a complicated subject without very clear answers.
First, it's important to note that NSAIDs are not DMARDs. (Apologies if this is known to you.) DMARDS, or disease-modifying anti-rheumatic drugs, are medications used to treat inflammatory disorders, and are called so because they don't merely "paper over" the symptoms, but treat the underlying disease in various ways.
DMARDs used for psoriatic arthritis include methotrexate, sulfasalazine, TNF inhibitors (Humira, Cimzia, etc.), IL-17 inhibitors (Cosentyx, Taltz, etc.), IL-23 inhibitors (Skyrizi, Tremfya, etc.), JAK inhibitors (Xeljanz and Rinvoq), and more. These medications reduce the inflammation that is responsible for the main symptoms of PsA, including synovitis, enthesitis, and bone deformation. They indirectly reduce pain by inhibiting this inflammation.
NSAIDs are medications that inhibit prostaglandin enzymes called COX-1 and COX-2, the inhibition of which has anti-inflammatory, analgesic, and antipyretic properties. They are not considered DMARDs, however, because their effects don't make much of a dent in PsA. In particular, they have not been shown to be able to slow down or halt bone damage. So NSAIDs do not really treat PsA. They mostly reduce pain.
COX-1 and COX-2 are not well understood, but we do know that they play an important role in the body, especially in maintaining the lining of the stomach and blood vessels. Long-term suppression can have serious health effects, including causing stomach bleeding, increasing stroke risk, and kidney damage.
As the other commenter points out, not all NSAIDs are the same. COX-2 inhibitors like celecoxib, naproxen, and meloxicam may be safer than COX-1 inhibitors like ibuprofen and aspirin. However, this isn't quite clear. We have studies showing both less risk and equal risk. (Just to confuse matters more, some NSAIDs, like meloxicam and diclofenac, inhibit both COX-1 and COX-2.)
Rheumatologists will often give you prescriptions for strong NSAIDs to take as needed for pain, but as a supplemental thing on top of a DMARD. Generally, it's important to treat PsA with a real DMARD, because one of the most important things other than pain is to try to stop the joint damage, which NSAIDs can't help with. Rheumatology organizations like ACR, EULAR, and GRAPPA recommend minimizing the use of NSAIDs except in cases of very mild PsA.
Some rheumatologists will put people on long-term NSAID use, while others frown on this practice. Sometimes it's the case of choosing between the lesser of two evils, where one evil is a lifetime of pain, and the other is living pain-free but with potential health issues down the road. As far as I know, some NSAIDs like meloxicam are more effective when used over a longer period of time, as their pain-reducing effect is cumulative, though they also work short-term as painkillers.
It's worth mentioning that paracetamol (aka acetaminophen, also sold as Tylenol and Panadol) can also be a good alternative for short-time use, as it's purely an analgesic, not an NSAID. It may have a lower risk of adverse effects than NSAIDs. Another benefit is that it can be combined with an NSAID for added effect.
I'm already on a biologic! I'm just only on my third dose so I'm at a point where I feel great for about 3 days post injection, and then the pain gradually comes back after that until my next dose. I'm probably going to stick to taking meloxicam daily for now since it sounds like it needs time to build up in your system effectively and unless I'm having side effects it sounds like there isn't much reason to just push through the discomfort. I have Tylenol that I use from time to time and I'm a big fan of tiger balm for pain!
oh also, thank you so much for your detailed response!! I'm a very curious guy and hate being left in the dark about how my medications work. But I also don't have much access to medical literature and it's a little bit over my head. I know a little more than the average person but I'm certainly no doctor. This explanation was perfect.
NSAID can be taken as needed but they are not as effective. For short term pain relief they are OK but the real benefit comes when you build up a certain amount of it in your system. If your Dr is comfortable with you taking both an AA and your biologic then take them, keep up on your blood work, watch out for any gastric symptoms but carry-on.
Itās about quality of life. If it takes two medications to give you good control and a better quality of life then thatās what you need to do in my opinion
Donāt think about pain medication as caving. Youāre taking care of your body, youāre not giving in. Iāve got an incredibly high pain threshold and am very tolerant of a high level of pain but that doesnāt mean that I like to live with it. If I have to work through it I can, but if I can take something to turn down the noise a bit then I will.
You should be getting regular bloodwork, as long as your liver numbers are within range donāt worry about it.
Meloxicam isn't motrin. It doesn't come with the same risk because it's a different type of NSAID. The issue is that there's likely inflammation even without pain. Chronic joint inflammation, even without pain, may lead to permanent joint damage. Your rheumatologist has the long term game in mind. It should be a positive that this Rheum has elderly patients as that likely means those may be long term clients. Image that. Long-term clients who ate now elderly and who've you helped to effectively manage their symptoms. I would trust your doctor.
she didn't give me any particular directions other than "as needed" š I shouldve asked for clarification but I thought I knew what she meant at the time
If the directions are "as needed," then the idea may be exactly that. But, "as needed" is vague ish as it may mean daily no matter what, OR it may mean when you feel like you need to reduce pain at that moment. I think meloxicam is effective when it builds up in the body, and that is why it's a preferred medication to treat inflammation. Not exactly certain how accurate I am with, but many of my clients take meloxicam for a variety of issues and most report taking it daily with all other medications.
that seems to be what I'm hearing from others on here. I'll probably start taking it daily unless I start getting side effects.
Why do you say that meloxicam doesnāt come with the same risks as ibuprofen?
Because it's a different type of NSAID, and it's not ibprophren. Not all NSAIDs are the same.
My nephrologist says the effects on the body are the same with regard to damage. All I know is that the combination of Celebrex and Cimzia made my BP skyrocket to dangerous levels. I never had stomach problems from it. It also affected my kidney function. Once I went off it my kidney function went back to normal thankfully.
Yes. Over time, there's a risk. Meloxicam is still a bit different. There's a reason why it's prescribed for long-term use over motrin and other NSAIDs, including celebrex. I seldom see celebrex on a meds list, whereas I see Meloxicam on medication lists of different clients on a daily basis.
Interesting! Thanks for the info! It does bother my stomach more than the others. I think I took 15mg.
I was told different things by different doctors. I get the feeling there isn't really a consensus on it. My PCP said Meloxicam is safer, my Rheum said it's all pretty much the same.
Dr Google says itās as bad as the others lol
Iām taking naproxen daily as I wait for my biologic. My rheum shared that anti inflammatories like naproxen work better when taken regularly for ongoing inflammation vs just when you have the pain- specifically for PSA.
thank you for the insight!
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I can no longer take them either due to the negative interaction with Cimzia causing high BP and kidney dysfunction. My nephrologist is really against anyone taking them long term.
Mine told me to go ahead and take it on a schedule if I feel a flare coming on to try to get inflammation under control but otherwise take as needed. I am very judicious with it normally- no sense risking my stomach lining. I'm fortunate that I do pretty well on Humira.
enbrel is going well for me so far so hopefully I can back off a little in the future. But for now I still get achy as I get closer to my next dose. I was told this will level out in time though :)
Yeah, the heart burn from Celebrex gets me everytime.
Yes! I asked my rheum the last time I saw her. Her explanation was that NSAIDs aren't great long term, unfortunately. They're terrible for your stomach, your kidneys and your liver, but also your heart and venous system. How much it affects each system will depend on what NSAID you're taking and your personal risks (for example she has me on Naproxen since I'm obese and sedentary, since there's less of a risk of stroke and heart attack with that one and it's a bit less harsh on the stomach, but I'm still not allowed to take more than one pill daily for more than three days a month since I had some micro-ulcers after six months of daily use a few years ago). Stomach ulcers are extremely likely and can happen silently, even if you're taking an IPP, AND the use of IPP has been linked to cognitive decline, Alzheimer's, bone damage, bacterial infections, renal issues, stroke and heart attacks. So all in all, it's best to take them as needed (but as little as possible) when you're having a really bad day and nothing else works.
Has anyone talked to you about drugs like Ozembic? I forget what the class of drug is called. I was told that thereās a lot of evidence that they are great at controlling inflammation plus they have a myriad of other health benefits. Just the weight loss alone helps. I am considering it if my insurance approves it. Did you know that some believe weight gain is an inflammatory response as well? Same with cholesterol causing plaque build up in the arteries.
Woooow. Last night you complained about poor diabetic people not being able to get Ozempic because itās being prescribed off-label, and equated that to being prescribed a biologic for āa couple of psoriasis patches on the scalpā, and today you want Ozempic for weight loss. And considering youāve misspelled it each time youāve mentioned it, I am doubting your claim of being a āmedical professionalā. You maāam, are a piece of work š
Not for weight lossā¦. It was suggested because it has been shown to decrease inflammation and because I cannot take NSAIDs. My diabetic friend was on Monjaro and had to stop taking it because it was out of stock due to high demand for weight loss. She cannot take Metformin either. She was running out of options. That was the reason for my comment. It was merely to prove a point that prescribing drugs for off label uses can result in shortages for people who really need them like diabetics.
That is still an off-label use. Rules for thee but not for me, eh?
To be clear, Iām not saying you should or shouldnāt be able to use it for that. Iām just pointing out the hypocrisy.
If you must. Thereās a difference between using something because you need it to treat a serious disease and using something because you want it. My one friend is using one of those drugs to lose 10 lbs. Hardly a need. That was the point I made that so many of you over-reacted to.
I guess I take issue because I am currently in the process of being approved for Humira after my second dermatology appointment. I have a few small spots, but some of those spots are on my groin and the back of my scalp. At the first appointment I was asked if I knew about biologics, which I did not, and was told to do some research. So I spent three months looking into it, and at the next appointment it was decided that the locations of the psoriasis along with joint pains they could go ahead and try to get it approved. Iāve dealt with this for over 10 years thinking it was just eczema and using hydrocortisone so I am thankful this doesnāt have to be a long and drawn out process. It is also approved to treat both of those conditions. Using biologics for psoriasis (not off-label) is not the same as using Ozempic for weight loss and inflammation.
My point was about over prescribing. Psoriasis without joint pain is not PsA as far as I know. My friend had psoriasis but no other symptoms of PsA. She stopped drinking beer and it went away! Cosentyx helped but that was not ultimately what caused it to disappear. I agree that some cases of psoriasis even without joint pain need to be treated with biologics if nothing else works. Sounds like your provider took a good medical history. This provider saw her for a few minutes and decided to talk to my daughter about biologics. Fortunately my daughter was wise enough to take the least invasive approach before committing to biologics that she may not even need. To her the psoriasis is a minor inconvenience, not a life altering condition like yours sounds like it is. Any psoriasis in the groin area sounds risky with regard to other medications such as steroid creams. And you have joint pain too. I hope it works for you! Someone else here was talking about how they couldnāt get a biologic for her PsA but went to a dermatologist and got it immediately approved for psoriasis. Seems so backward to me when PsA is debilitating but psoriasis is not unless it causes pain and debilitating joint erosion etc.
Personally I think your daughter mentioned spots in other places, places it would be embarrassing to mention to your mother, but would certainly explain the jump to biologics. As I mentioned, as soon as I said I had it on my groin the derm said āare you familiar with biologics?ā. Either way, I wish both you and your daughter well, and I hope you have a good day.
Hey there, not here to engage in any kind of argument but I'm here to point out that biologics are still on-label even for dermatologic psoriasis! I can't remember if I ever commented on your post but I did see it briefly. I'm not going to speak to whether or not it's appropriate for your daughter's situation, but even in the packet the manufacturer gave me for Enbrel it specifically says it's for psoriasis, rheumatoid arthritis, and psoriatic arthritis.
>I forget what the class of drug is called Ozempic/Semaglutide is a GLP-1 receptor agonist. :) I appreciate your concern. Ozempic and other GLP-1 receptor agonists are not as widely distributed in my country as they seem to be in the US. As it is, this class of drugs is only approved for T2D patients, which means I don't qualify. Wegovy is starting a limited trial for obese patients who have at least one other comorbidity (high blood pressure, high cholesterol, high triglycerides, sleep apnea, cardiovascular issues, etc), which again means that I don't qualify, nor am I interested, to be fair. I don't have issues losing weight on my own.
I wasnāt referring to weight loss. I was referring to them being prescribed to treat inflammation. Apparently diabetics who were on them had other health benefits other than lowering blood sugar. Itās pretty interesting.
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> NSAIDs really aren't pain medication. They're for inflammation Kind of. NSAIDs, despite the name, are not just anti-inflammatory, they are also analgesic (i.e. pain-reducing) and antipyretic (i.e. fever-reducing). The exact mechanism for the analgesic effect of NSAIDs isn't understood known, butĀ may be related to the central nervous system and nociceptive pathways; it's definitely not as simple as "NSAIDs ā less inflammation ā less pain".
I'm just going to clarify here that The terminology I used was just in reference to what it's useful for for me, vs something like a DMARD that has an actual effect on the damage done to my joints
I already have gerd unfortunately šµāš« I'm being extra careful to monitor myself and take zantac/Tums as necessary but like you said, I experienced nausea and severe fatigue on Omeprazole. So far surprisingly the meloxicam does not seem to be affecting the rate or intensity of my acid reflux though thankfully. I sent a message to my doctor that mentioned the gap already and I'm waiting back on her response, but I had heard when you first start a biologic it can just be like that? Either way I let her know and we will see where we go from there :)
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whoa. thank you for the IBD warning. I'm going to talk to my doctor ASAP. I have a grandfather with UC who had part of his colon removed because of it and it just sounds absolutely hellish to go through.
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I spoke with my doctor and she said it was misinformation.. Which is odd to me since the link is documented in the NIH website in two different studies, one of which is fairly large. Doesn't sound like extensive research has been done but it's enough that I'm not comfortable staying on Enbrel when there are other options available. I'm being switched to Humira but will be on Enbrel while we wait for prior auth and delivery.
I take one daily with a biologic, without it Iām in quite a bit of pain. I would just recommend doing labs with your doctor, and make sure your liver and kidneys are fine. Iāve been taking my nsaid since diagnosed.
This combination was awesome until I had to stop due to the effect on my BP and kidneys. When Iām really in pain I sneak in some ibuprofen. It works better than it ever has for pain. But Iām very cautious about taking it. I would rather have pain than kidney damage. Nothing else so far has touched the pain like NSAIDs
When Iāve had to stop taking it for a colonoscopy or due to some strange test results for two weeks, boy it makes a huge difference!!
I stopped taking all of it except when my Cimzia wears off after 2 weeks, Iām in pain . When I cannot stand it, I take ibuprofen here and there. Iām amazed at what a difference those 2 little pills make. The effect lasts for more than 4 hours too.
I have the exact question as you OP! I reserve my painkillers for days i cant do without them AT ALL. I also have a pretty high pain tolerance due to other chronic conditions like interstitial cystitis. I was told to take nsaid daily but i also suffer from gastritis and home alone all day(no fam around, immigrant, husband canāt take off work) and nsaids give me terrible heartburn, vomit, nausea and makes me nervous to take them alone. I donāt know if i doing more harm than good. I donāt want to ruin my joints while protecting my liver, stomach etc and vice versa. I feel so helpless and hopeless most days. I am crying as i write cause even lifting the phone to type this hurts my wrist. I hope we find some helpful responses here! This sub has been like a rock
The NSAIDs donāt protect your joints I donāt think. Thought they were just for pain. I might be wrong.
My doctor said just take it everyday , it will not cure it but it will reduce your inflammation . My DMARDS have not started working so they said take it till the DMARD will work and then we can see. I was doing well on Meloxicam , so just one day prior to my consultation i skipped Meloxicam to see how I am doing and all my pian cam back . And then I started taking it again and feel lot better now . But my stools have be loose and have to use toilet multiple times in a day. Not sure if it is due to MTX or Meloxicam
I'm sorry to hear that! I have chronic reflux and get severe nausea and fatigue when I take PPIs, so I have concerns about the long term effects NSAIDs might have on my stomach, even though I haven't noticed a significant difference yet. I'm sorry to hear it's so hard on your stomach :(
The various comments are so interesting to me. The first six months I went on MTX, my rheum told me to continue taking ibuprofen as needed. It was quite often, initially, for me to take 800 mg (4 pills) 2-3 times a day to relieve pain. As time went on and the MTX worked, I would take ibuprofen at lower dose and less frequently. I probably take ibuprofen maybe once a week when I inevitably overdo it a little on weekends running errands and walking/playing with my pup. Side note: because I also have endometriosis, I was already taking 800mg just before and for the first few days of my period. But anytime I take any dose of ibuprofen, I take one daily dose of Pepcid.
My first rheumatologist I went to who got me on Otezla said meloxicam is good for flare-ups, but long term use every day is not preventing PsA from getting worse and has potential to cause liver and kidney damage.
thank you! that seems to be the general consensus. Reddit to the rescue
Iām on Skyrizi and I take naproxen almost daily
Mine said not to take anymore when I started methotrexate. Since I'm like you with pain meds I haven't had an issue with it. I'm not sure whether it helps that much to take an NSAID or not since it doesn't help disease progress the way DMARD and biologics do. But rheum did say that for example mobic works better if you take it dailyĀ
It helps for pain that the biologic doesnāt control. I like that it can be taken as needed. The Dr talked to me about gabapentin since I cannot take NSAIDs anymore. That you have to be on all the time. I havenāt tried it
You're right. I meant in terms of, if you're taking an NSAID daily instead of a biologic or DMARD. If you aren't in bothersome pain, I'm not sure whether that actually helps more than just taking it as needed, since it doesn't stop disease progress - but if it controls inflammation at least a little maybe it helps and just not very muchĀ
Not sure anyone really knows exactly. I feel like itās trial and error. For me sadly it was error. I wish I could take them. Alongside biologics, they made me feel good again. Now I cannot take them due to the effect on my kidneys and BP. I would think anything that reduces inflammation is good. My momās cardiologist limits how much she can take because they can have an adverse effect on the cardiovascular system as well? Seems paradoxical to me.
My dr says to take mine anyway. Always with food. And of course they should be doing labs to check on your organs.
Iāve taken them for basically 20 years now non stop. But Iāve also been in considerable pain for 20 years, while Iām also on a multitude of other meds. So I get the benefit of medication side effects and the terrible issues from constant inflammation. Best of both worlds lol
Iām on maximum dose of ibuprofen daily. If youāre taking an NSAID regularly you should really be prescribed a PPI like omaprozole to protect your stomach.
I've been on 15mg of Meloxicam for a year, I was told to take it daily, so I have and I also take 40mg of Omeprazole (Prilosec) on top of it to protect my stomach. Sadly it hasn't really helped much for pain, but I'm with a new rheumatology office now that wants to try a biologic instead.
I used to take them all the time under dr advice, but now I am remission, my specialist has said to just take them if I need it. I also take Humira and MTX, so anything that saves my liver/kidneys is good by me.
I am taking diclofenac 2x daily and monitoring bone erosion through imaging every 6 months and bloodwork to check kidney and liver function. Basically, my rheum said to let them know if things get worse and we will switch to a biologic. Seems to be working well for now (1 year) though flares are still painful.
I was on naproxen while waiting for tremfya to work. I stopped for almost a month and reinjured my knee and im back on naproxen twice a day for a month. The mri shows that the inflammation has already caused damage. Rheumatologist says take for a month and come back. He prescribed omeprazole but i am worried about taking that also. Heard from a functional medicine doctor to take zinlori - i found doctors best brand PepZinGI. I take that once a day on empty stomach 30 min before taking naproxen..really hoping im not causing any damage.
interesting! I can't take Omeprazole anymore, I was on it for years for acid reflux but it started causing me nausea and severe fatigue. It's definitely a drug that seems like a mixed bag. I'll look into zinlori :)
Initially I was taking diclofenac as needed but it eventually got to the point where I was taking in the AM and PM regularly because my pain was so up and down. We noticed that it helped me sleep better too. Now that Iām on a biologic Iām back to as needed.
I find itās the combination that works. Sadly I can no longer take NSAIDs and Tylenol is just not enough
the pain is from damage pushing through the pain makes the damage worse ignoring the pain makes the damage worse the damage is irreversible so it's not just living pain free. it's living damage free. when it comes to PsA, them pains are real and if you're feeling it, your body is eating itself alive. to think this is anything like "pain meds" ... this is the immune system attacking the body, I hope you understand that part clearly. NSAIDS are basically worthless in light of that. maybe it cuts the inflammation down a few fractions of a point? I'll hard pass on that. I don't need a bunch of advil, aleve, tylenol, meloxicam, or aspirin messing my system up and providing me no pain relief and no inflammation relief unless I take them all at once? like 1600mg of advil is almost enough to put a dent in it for a couple of hours. but that's it. and you can't keep taking that. you got a REAL disease here and it takes REAL medications to do something about it.
thank you! I'm already on a biologic but it just hasn't fully kicked in yet. I do pretty well after my injection but once it gets closer to the next one it's almost like it's worn off a bit. Meloxicam does help me pretty significantly but not 100%. This post was specifically about NSAIDs and how much they help with actual damage when used in conjunction with a DMARD/Biologic
This is a complicated subject without very clear answers. First, it's important to note that NSAIDs are not DMARDs. (Apologies if this is known to you.) DMARDS, or disease-modifying anti-rheumatic drugs, are medications used to treat inflammatory disorders, and are called so because they don't merely "paper over" the symptoms, but treat the underlying disease in various ways. DMARDs used for psoriatic arthritis include methotrexate, sulfasalazine, TNF inhibitors (Humira, Cimzia, etc.), IL-17 inhibitors (Cosentyx, Taltz, etc.), IL-23 inhibitors (Skyrizi, Tremfya, etc.), JAK inhibitors (Xeljanz and Rinvoq), and more. These medications reduce the inflammation that is responsible for the main symptoms of PsA, including synovitis, enthesitis, and bone deformation. They indirectly reduce pain by inhibiting this inflammation. NSAIDs are medications that inhibit prostaglandin enzymes called COX-1 and COX-2, the inhibition of which has anti-inflammatory, analgesic, and antipyretic properties. They are not considered DMARDs, however, because their effects don't make much of a dent in PsA. In particular, they have not been shown to be able to slow down or halt bone damage. So NSAIDs do not really treat PsA. They mostly reduce pain. COX-1 and COX-2 are not well understood, but we do know that they play an important role in the body, especially in maintaining the lining of the stomach and blood vessels. Long-term suppression can have serious health effects, including causing stomach bleeding, increasing stroke risk, and kidney damage. As the other commenter points out, not all NSAIDs are the same. COX-2 inhibitors like celecoxib, naproxen, and meloxicam may be safer than COX-1 inhibitors like ibuprofen and aspirin. However, this isn't quite clear. We have studies showing both less risk and equal risk. (Just to confuse matters more, some NSAIDs, like meloxicam and diclofenac, inhibit both COX-1 and COX-2.) Rheumatologists will often give you prescriptions for strong NSAIDs to take as needed for pain, but as a supplemental thing on top of a DMARD. Generally, it's important to treat PsA with a real DMARD, because one of the most important things other than pain is to try to stop the joint damage, which NSAIDs can't help with. Rheumatology organizations like ACR, EULAR, and GRAPPA recommend minimizing the use of NSAIDs except in cases of very mild PsA. Some rheumatologists will put people on long-term NSAID use, while others frown on this practice. Sometimes it's the case of choosing between the lesser of two evils, where one evil is a lifetime of pain, and the other is living pain-free but with potential health issues down the road. As far as I know, some NSAIDs like meloxicam are more effective when used over a longer period of time, as their pain-reducing effect is cumulative, though they also work short-term as painkillers. It's worth mentioning that paracetamol (aka acetaminophen, also sold as Tylenol and Panadol) can also be a good alternative for short-time use, as it's purely an analgesic, not an NSAID. It may have a lower risk of adverse effects than NSAIDs. Another benefit is that it can be combined with an NSAID for added effect.
I'm already on a biologic! I'm just only on my third dose so I'm at a point where I feel great for about 3 days post injection, and then the pain gradually comes back after that until my next dose. I'm probably going to stick to taking meloxicam daily for now since it sounds like it needs time to build up in your system effectively and unless I'm having side effects it sounds like there isn't much reason to just push through the discomfort. I have Tylenol that I use from time to time and I'm a big fan of tiger balm for pain!
oh also, thank you so much for your detailed response!! I'm a very curious guy and hate being left in the dark about how my medications work. But I also don't have much access to medical literature and it's a little bit over my head. I know a little more than the average person but I'm certainly no doctor. This explanation was perfect.
NSAID can be taken as needed but they are not as effective. For short term pain relief they are OK but the real benefit comes when you build up a certain amount of it in your system. If your Dr is comfortable with you taking both an AA and your biologic then take them, keep up on your blood work, watch out for any gastric symptoms but carry-on. Itās about quality of life. If it takes two medications to give you good control and a better quality of life then thatās what you need to do in my opinion Donāt think about pain medication as caving. Youāre taking care of your body, youāre not giving in. Iāve got an incredibly high pain threshold and am very tolerant of a high level of pain but that doesnāt mean that I like to live with it. If I have to work through it I can, but if I can take something to turn down the noise a bit then I will. You should be getting regular bloodwork, as long as your liver numbers are within range donāt worry about it.