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The focus for management of osteoarthritis is around improving function and reducing pain.  Of course, we want to reduce pain in the safest way possible, and the safest way is different for different people.  For most people, acetaminophen (Tylenol) is one of the safest pain relievers.  While most individuals will use acetaminophen when the pain is worst, for those with chronic pain, acetaminophen is more effective when used on a regular basis to prevent pain flares, never using more than recommended on the bottle.  Anti-inflammatories (NSAIDs) arguably may be more effective, but do have other side effect concerns, and should be avoided for those with kidney problems.  Topical anti-inflammatories are available which are likely safe even for those with kidney problems.  Cortisone injections are a safe option as well and certainly there is no limit how long you can have cortisone injections, as long as they are effective.

Finally, often forgotten but perhaps most important is the role for physical and occupational therapy.  Maintaining range of motion and muscle strength is an important part of management of osteoarthritis, and by its very nature is safe.

There is limited data about the safety of entanercept or any of the other TNF antagonists during pregnancy and breastfeeding.   From the available data, there is no clear indication that TNF antagonists are problematic in pregnancy and breastfeeding.  As rheumatoid arthritis goes into remission for many women, and with some uncertainty of safety still present, most women will stop TNF blockers when they know they are pregnant.  That said, there are many women who have had successful pregnancies while using TNF antagonists.

For breastfeeding, officially, it is not recommended by the pharmaceutical manufacturers of these medications.  However, there is no data to suggest it is harmful to the baby.  There is a very small amount of TNF antagonist that is excreted in mother’s milk; it is thought, though, that the medication is broken down in the baby’s gut and therefore is likely not harmful.  Ultimately, each individual must balance this small unknown risk and the functional abilities of the mother to care for their newborn if they have active inflammatory arthritis.

While not a common occurrence for most people on methotrexate for their arthritis, hair loss certainly is a known side effect.  Certainly this should be discussed with your rheumatologist to determine the best option in any particular case.  For some, increasing folic acid intake may be quite helpful at reversing the hair loss.  For others, lowering methotrexate or considering an alternative may be necessary.  Making the appropriate adjustments with your rheumatologist will ensure the best chance of reducing any side effects while still ensuring your arthritis is, or becomes, under good control.  Keep in mind, even if the hair loss stops, it unfortunately can take months before you notice the improvement.  Hair loss from methotrexate is usually reversible; hair will grow back.

Rheumatoid arthritis can involve essentially any joint in the body with few exceptions.  This includes both small joints, such as those in the hands and feet, as well as large joints, such as the shoulders, knees, and hips.  Treatment typically is the same regardless of the joints involved.

Among the many potential complications of prednisone use, osteoporosis is one of them.  The risk particularly increases if you require more than 3 months of prednisone.  In this case, calcium and Vitamin D intake are very important.  Recommendations from Calcium intake range from 1000 – 1500 mg per day, and includes calcium from both diet and supplement.  Dietary calcium is likely more ideal.  Current Vitamin D guidelines suggest intake of 800 – 2000 units daily.  Dietary Vitamin D is usually not sufficient and should be supplemented.  For individuals on prednisone, often your physician may speak to you about the addition of a medication in a class called bisphosphonates, which also will help protect the bone.

Sjogren’s syndrome is an autoimmune disease with its most common symptom being dry eyes and dry mouth.  Read here for more on rheumatoid arthritis, and check out this previous answer for more information.  However, you should know there is no definitive test for rheumatoid arthritis or Sjogren’s syndrome.  There are tests that are associated with these conditions, but they are not definitive.  To make a diagnosis of most rheumatic diseases, including rheumatoid arthritis and Sjogren’s syndrome, an expert in these conditions needs to take a good history and complete a physical examination; then, it is appropriate to look at any investigations and determine how they best fit all together.  There are many patients we see who test “positive” for these blood tests, but don’t have – and may never have – a rheumatic disease.

Mixed connective tissue disease (MCTD) is similar and has some overlap to systemic lupus.  By definition, an antibody test called RNP should be positive in MCTD.  However, as in many conditions and tests in rheumatology, a positive test does not necessarily diagnose a disease.  Conversely, a negative test does not always rule out a disease either.  To truly make a diagnosis of MCTD, lupus, rheumatoid arthritis, or many other rheumatic diseases, your doctor/rheumatologist needs to review your personal history with you, complete a physical examination, review the appropriate tests and put all that information together to make an informed diagnosis.

Osteoarthritis to the base of the thumb is a common spot to have osteoarthritis.  Treatment is aimed at managing symptoms and improving function.  Because of this, treatment options that works well for one person may not be as effective for the someone else.  We cover many treatment options on our page for osteoarthritis, but one could consider acetaminophen, NSAIDs, a splint, physiotherapy, topical anti-inflammatories, and/or a cortisone injection, amongst other options.  In terms of natural products, please visit our pages on glucosamine, Sierra Sil, and other available natural health products to review them for yourself.

Vaccines, or immunizations, come in two broad forms.  Most are ok to receive when you have an underlying rheumatic disease and on treatment for it, including methotrexate or even biologics.   For that reason, rheumatologists generally encourage their patients to get the annual flu shot, and to receive the pneumonia vaccine as well.  However, for those vaccines that may have a live component to them, patients may need to be cautious depending on which medication they are on, as you may be at increased risk for developing the condition you are trying to protect yourself from.  While less concerning, these vaccines also may be less effective when on these medications.  If you are able to receive the vaccine before starting them, all the better.  It’s important to discuss the details of any live attenuated vaccine with your rheumatologist to ensure it’s right for you.

One of the manifestations of rheumatoid arthritis outside the joint is the development of rheumatoid nodules.  These occur in just under 10% of patients with rheumatoid arthritis and is one of the more common skin manifestation of rheumatoid arthritis.  They often occur on pressure surfaces e.g. elbow, but can occur elsewhere as well.  For most individuals, they are asymptomatic and specific treatment is not necessary for them.  Steroid injections or surgical removal is sometimes considered, although control of the inflammatory arthritis often improves the nodules too.  Paradoxically, in some patients treated with methotrexate – the gold standard for rheumatoid arthritis treatment – the nodules can worsen, and stopping methotrexate can lead to improvement.