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Answers: Page 5 of 13
If you review medication interactions for methotrexate, the list appears long, but in fact, is not entirely accurate. There are many medications listed that you should not take with methotrexate, but most of them are only theoretical, whereas we have years of experience knowing these combinations are in fact safe.
It is very common to use methotrexate and sulfasalazine together, and it is considered safe. Similarly, some texts suggest methotrexate should not be used with anti-inflammatories (NSAIDs) or stomach protector medications called proton pump inhibitors (PPIs). Again, these combinations are used frequently. In fact, it is not uncommon that some arthritis patients are on methotrexate, sulfasalazine, ibuprofen and omeprazole (a PPI) all at the same time.
We do recommend holding methotrexate if you require a sulfa-based or penicillin-based antibiotic, but these are really the only interactions we watch for.
Many people are asking: I have rheumatoid arthritis. Will I be able to get the COVID-19 vaccine when it becomes available?
As we answer this (Dec/2020), we do not fully know the answer yet. It is a complicated question as it relates to both the safety of the vaccine, and how well it works. Safety is really the key part, and because the technology being used to develop the COVID19 vaccines is mostly new, we do not have the experience to know for sure if it’s safe. That said, there is currently no reason to think it won’t be safe, as they are not LIVE vaccines, which are contraindicated for many individuals with arthritis because of the medications they are on. As we get closer to having vaccine available, we expect more data to also come out which will help inform this decision. Stay tuned as we learn more, and check with your rheumatologist for your particular situation.
Click here to visit our COVID-19 vaccine information page, which we will keep up to date, or our YouTube site with COVID-19 information videos.
Jonathan from Calgary asks: Is there any specific advice recommended for rheumatology patients and COVID-19?
Please click here to our page on COVID-19. We will try to keep this information up to date, but the situation remains fluid.
Lily from Edmonton asks: Is there a generic version of Enbrel or Etanercept that will do the same thing Enbrel does for less cost? I can’t get Enbrel covered anymore.
Biosimilars are new medications which are biologically similar to original biologics. In Canada, as of 2020, Enbrel and Remicade both have biosimilars available and many medication insurance plans are, or are considering, not providing coverage to the original biologic, but rather the less expensive biosimilar. For most patients, the biosimilar should be as effective and safe. However, for each individual, it is important to speak with your rheumatologist to make the right decision for you. For more information on biosimilars, please click here.
Austin from Toronto asks: I tested CCP positive but have no symptoms of rheumatoid arthritis. Am I more likely to get it now?
Anti cyclic citrullinated peptide (anti CCP) is a test which is highly associated with rheumatoid arthritis. It is not necessary to test positive to have rheumatoid arthritis, but most individuals who are positive have or will develop RA. That being said, there are exceptions to this rule, particularly if the test is not strongly positive. In particular, there is growing data to suggest individuals with pulmonary (lung) issues may test positive and not develop RA. In some instances, it may be worthwhile monitoring your joints with a rheumatologist over time to ensure you do not develop rheumatoid arthritis.
Every province has slightly different rules for coverage of advanced therapies such as tofacinitib, and biologics. That said, in most situations, working with your current rheumatologist, or your new rheumatologist if you are planning a move to Alberta, a solution is found to ensure you can continue to receive the treatment that makes you well.
Mahdi from Afghanistan asks: My wife was told she has Takayasu’s arteritis, but her tests (ESR, CRP) came back normal. Is this possible?
Takayasu’s arteritis is a form of vasculitis. It is unique in that it affects large blood vessels, and is generally diagnosed in individuals under the age of 40. It causes inflammation in the blood vessels, which can disrupt blood flow, or cause the wall of the blood vessel to become thinner than it should. While markers for inflammation in blood tests can often be elevated in most forms of vasculitis, it is also possible for them to be normal. A normal test does not rule out Takayasu’s arteritis. While not for everyone, in some patients, a normal ESR or CRP may indicate that the disease is not currently active; damage has been done to the blood vessel causing blood flow disruption (no pulse), but smaller blood vessels have developed to provide the necessary blood flow in its place.
The treatment goal for any inflammatory arthritis is to reach remission. Those in remission should be able to participate in all their normal activities, including work. Before reaching remission, patients should listen to their bodies. If it hurts when you are doing something, it is important not to ignore that. However, that line of what is too much is going to be different for everyone. The important thing to know is that being active is not going to make the underlying disease worse. In fact, exercise in moderation is considered a positive step for those with inflammatory arthritis.
HIV, or Human Immunodeficiency Virus, is a virus that affects the immune system. In some individuals infected with HIV, it can present with musculoskeletal or rheumatic diseases, ranging from fibromyalgia, HIV-related arthritis, vasculitis or psoriatic arthritis. For most of these, treatment of HIV will also effectively treat the arthritis too.
Fibromyalgia often presents as diffuse pain, poor or non-restorative sleep, and a decrease in exercise. A doctor’s role is to discuss this presentation with a patient, and also rule out other conditions that may present similarly. Once a diagnosis is made, the first key options for treatment include education around pain management, sleep and exercise. While rheumatologists certainly see patients with fibromyalgia, many family physicians diagnose and manage patients with fibromyalgia as well. In Edmonton, there are a number of excellent education programs for fibromyalgia. Please see our fibromyalgia web page for more information and how to enroll.