RA, Methotrexate, Milkthistle and Liver

[2razor]

I have RA.
I have been taking 4 tabs of methotrexate one day a week.
I also take 1 folgard tab a day
I take prednisone only when the RA gets crazy.

I move to Florida from North Carolina August 2008.

Sadly the move coincided with the collapse of the economy etc.

All that said, I have been unemployed since arriving in FL. No insurance etc.

I finally have insurance again and have an appointment with a local Rheumatologist.

I have had no blood tests etc since August. I tried going off the Methotrexate, but the RA was relentless. I am aware of the possibility of liver problems and MTX. But really had no options.

2 questions....
I feel pretty good right now, minor stiffness in my hands, minimal morning issues.

Should I add Milkthistle to my daily meds for its reputed liver benefits?
What B vitamins, in what dose can I buy off the shelf (Walmart) to replace the Folgard Tabs?

Regards,

Ray

[Tom Plamondon PA-C]

Hello,
Thanks for writing in.

You have reported a history of RA and treatment with MTX and occasional prednisone. Questions are: Should milkthistle be added to protect the liver? and What OTC B vitamins can replace Folgard?

Milk thistle in some studies has lowered AST and ALT (liver enzymes) levels. Studies are inconclusion about living disease prevention. Side effect profile is limited to mild symptoms (GI upset, headache, rash...occasionally arthralgia). So, unless your liver enzymes are elevated, you could hold off on the milk thistle.

Folgard contain 0.8 mg folic acid, 115mcg cyanocobalamin (B12), and 10mg pyridoxine hcl (B6). So you should be able to find some OTC preparations combined or individually which amounts to Folgard.

Take care and keep us posted.

[2razor]

Hi,

Thank you for your response. To update....

I have been to the Rhuematologists.

X-rays shown increase joint deterioration in my hands and ankles. General function is fine. The stiffness doesn't go away anymore though.

Liver enzymes are Ok. I did go ahead and start the milk thistle. The doctor is aware of this but sees no issue up or down because of it.

I am on my first month of Humira + 5 tabs of methotrexate.
The Humira is 1 injection every 2 weeks. The methotrexate is 5 tabs per week. I take 3 one day and 2 the next day per the doctor.

I started a new job this past week. I may not be able to stay there. It is VERY physical. My hands are really taking a beating. My ankles are good till the last hour. By the end of the shift I can barely walk.

For my ankles specifically I have been using a product called bio-freeze. I massage it in after work. Wow... what a relief... :)

I am concerned about the heavy physical nature of my new job though. I don't know if "work" aggravates the RA or if I am just not used to real work and will adjust...

I guess the humira will take a while to kick in. If I don't feel better next week, I will start a round of Prednisone. I hate that stuff, but it works...

I am trying to weigh the work thing with the possibility I am just having a flare... Did the work cause it? I don't know.

[Tom Plamondon PA-C]

Hello,
I think some questions still remain about work intensity and medication efficacy but time will tell.
Hang in there and keep us posted.