RHUEMATOID ARTHRITIS AND BY-PASS SURGERY

Question
I had the rouen-y procedure May of 2004.  I have been in very good health since until 11/08 when I suddenly experienced excrutiating pain in my left wrist.  All that was found was slight arthritis and severe neuropathy which my GP didn't seem to be too concerned about.  I took a reducing treatment of prednisone, wore a brace and after about a month was out of pain and able to work again but with continued weakness in my hand.  Then in 2/09  I began waking up at night with both wrists and hands aching terrible.  Within weeks my fingers were swollen and every joint in my body was in excrutiating pain.  I could barely walk, could hardly function in my life.  Tests were ran, my RA factors as well as two other components that are checked when checking for this disease are elevated but according to my doctor, not as elevated as they "typically" see when someone is in as much pain as I was in.  This level of pain continued for 4 straight months and finally after two treatments of prednisone everything except my wrists and fingers are no longer constantly in pain.  My hands however are still always painful and I can barely use them.  I am having to wait 5 months to see a rhuematologist which means I won't be able to see one until October 1.  My concern is if it does finally get diagnosed as rhuematoid arthritis, what treatment options are there for me?  My doctor is adamant that anti-inflammatories are not an option, not even a topical gel that I would just spread on my skin.  Right now I am on disability and I fear that I may never be able to return to work

Answer
Sheryl,
I can see how this is a really tough situation, and unfortunately I agree with your doctor that standard anti-inflammatory meds are a bad idea with a gastric bypass.

Treatment of arthritis is not my area of expertise, but I can think of three potential options:
1) celebrex - this is in the general family of anti-inflammatory meds but in my experience it has a very low rate of ulcers or pouch irritation.  You should check with your surgeon before starting this med, but I believe that most surgeons consider it "OK."

2) steroid injections - if the inflammation is in a particular area, then injection of steroids in the area may help a lot, without causing any side effects for your body overall

3) anti-metabolites - this is a group of drugs that suppresses the immune system.  The one that I know of is methotrexate, and I believe there are a number of others which can be used for arthritis treatment.

Best of luck,
Dr JP

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