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Prednisone is a steroid, while leflunomide (Arava) is a disease modifying anti-rheumatic drug (DMARD) used to treat rheumatoid arthritis.  Another term for DMARDs is a steroid sparing agent, meaning they aim to achieve the same goals as steroids, but ideally with less side effects.   Prednisone works much faster than leflunomide, days versus weeks.  Because of that, it is not unusual for a patient to be started on both: Prednisone to help control symptoms short term and then stopped once leflunomide has begun to take effect.  This same idea would apply for most DMARDs.

When it comes to quitting most medications for arthritis, it is considered safe to just stop them.  You do not need to do it slowly over time.  This would apply to gold, which was the literal “gold standard” for treating RA years ago, but also to options like methotrexate, hydroxychloroquine, leflunomide, and the biologics.  The only one to be very cautious with is prednisone, which in most cases should NOT be stopped suddenly without input from your physician.

All that said, it is usually best to discuss with your rheumatologist prior to making this decision.  While safe, stopping medication does not mean there will not be consequences.  In particular, your rheumatologist can discuss with you the risk of your RA becoming active again when you stop your medication, and perhaps can provide strategies to help reduce those risks.

Whether or not medications can be taken at the same time, close in time, or need a brief break in time, depends on the medications being considered.  For leflunomide, it is common to use it at the same time as many biologics.  If it is being stopped, there is typically no reason to wait to start the biologic.  They should not interfere with each other.  For rheumatoid arthritis, it is, in fact, very common to use a number of the disease modifying medications (DMARDs) together, and often in combination with a biologic.  For instance, to be on methotrexate, hydroxychloroquine, and sulfasalazine at the same time is a common regimen known as triple therapy.  It is also common to be on a regular DMARD while on a biologic.  It is not considered safe to be on two biologics at the same time.

While rheumatologists are often thought of as treating arthritis only, there are many conditions that we treat that can affect other areas of the body.  Vasculitis, or inflammation of blood vessels, is an area of expertise for rheumatologists, including Giant Cell Arteritis.  Examples of other conditions which can affect other organs besides joints include lupus, scleroderma, polymyalgia rheumatica, myositis, and osteoporosis.

Like many rheumatic conditions, a diagnosis of Scleroderma is not always made based on lab tests.  A good history and physical examination by a scleroderma specialist – usually a rheumatologist – combined with appropriate investigations, will help lead to the correct diagnosis and treatment plan.  While there are a number of blood tests that can be associated with scleroderma, it is possible for them to be negative and still have the condition.

Fibromyalgia is a condition that presents with diffuse muscle and joint pain, poor sleep, and fatigue. Some patients also describe stomach ailments and have history of headaches. The symptoms may often be vague, but can be debilitating to patients with it.  Rheumatologists often see patients with fibromyalgia before a clear diagnosis has been made.  For some people, it is important to rule out other possibilities, including conditions such as rheumatoid arthritis, polymyalgia rheumatica, and other autoimmune inflammatory diseases which require a different treatment approach.

If a diagnosis of fibromyalgia has been established, there is no specific expertise a rheumatologist has compared to other physicians, including family physicians.  The first steps in managing fibromyalgia include a slow progressive increase in exercise, working on sleep hygiene, and learning more about fibromyalgia.  Please visit our webpage on fibromyalgia to learn more the condition and resources available in the Edmonton area.

Diclofenac is an example of an NSAID (anti-inflammatory).  Similar medications include naproxen (Aleve), ibuprofen (Advil, Motrin) or celecoxib (Celebrex).  There are many potential side effects of NSAIDs, including irritation/inflammation to the stomach lining.   Ultimately, this can lead to a stomach ulcer in some individuals.  Medications called proton pump inhibitors (PPIs), like pantoprazole, can help reduce the risk of this happening.  However, one should consider stopping the NSAID if the stomach discomfort continues despite being on a PPI.  Everyone’s individual risk from NSAIDs is different and should be strongly considered when starting a NSAID.  A conversation with your doctor to balance the benefits and risks is always a good idea.

Years ago, the answer to this question would be very different.  Older data suggest that half of patients with rheumatoid arthritis will be disabled and unable to work after 10 years with the disease.  Today, this is unlikely the case, as treatment for rheumatoid arthritis has improved; our goal of treatment is remission, meaning no pain, stiffness, or swelling, and ideally doing everything you want to do in life.  This includes the ability to work.  For some individuals, it may not be a realistic goal to work while rheumatoid arthritis is still active, and some find it hard to return to work later on.  Ultimately, each person needs to be comfortable with their choice, as there are many different factors to consider when it comes to work.  However, work itself is not going to make rheumatoid arthritis worse.

For most rheumatology patients whose disease is under control, travel should not be a major issue.  Many patients are concerned because they may have medications that require syringes and needles, but your rheumatologist can provide you a travel letter which can be presented if requested by authorities.  For patients on intravenous medications, arrangements often can be made to ensure minimal interruption to your treatment.  The bottom line is to speak with your rheumatologist; if your disease is under good control, you should be able to lead a full and complete life.  If that includes travel, so be it!

There are animal based studies that suggest a concern about using methotrexate and any anti-inflammatory, including diclofenac, together.  However, this combination is used commonly in patients with rheumatoid arthritis without any significant concerns.  It is an appropriate way to control symptoms while waiting for the disease modifying agents, such as methotrexate and hydroxychloroquine, to start working.  While all these medications have potential side effects, there are no significant increased risks when used together.