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Dr. Abby
Dr. Abby, Board Certified MD
Category: Health
Satisfied Customers: 10330
Experience:  Family Physician, practicing medicine for over 10 years, United States
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I walk with crutches due to childhood polio. I also have a

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I walk with crutches due to childhood polio. I also have a genetic blood disorder named Von Wilbrand's disorder (spelling?) that is like hemophilia. I am a 67 year old female. This disorder can be inherited by either sex. Due to the strain on joints over years, I have osteoarthritis which I have been able to live with. Within the last three weeks, however, I have been in A LOT of pain. My hands and wrists are red and swollen to 1 1/2 or more regular size. My MD diagnosed me a few days ago with rheumatoid arthritis. Since I cannot take any aspirin, or NSAID's, what do I do? He has me on a rather heavy pain medication. It takes quite a while to take effect. I have to start at midnight, then dose at 4 a.m. then at 8:a m then get up and start to move as much as I can in order to do the few things I can do. I do have a lot of things on my agenda to get done, but have trouble showering and getting dressed. Since this is an auto immune disorder, a medical technician friend suggested an immune suppressent called Embrell. This sounds scary to me due to a lowered immune system. What else will I get? He also said there is
an NSAID gel named Voltarin Creme 1% (Dyclovinac Sodium). What do you think of these suggestions and do you have any other suggestions for a patient with this situation that cannot take NSAID's or simple aspirin?

Have you seen a rheumatologist?
Is the diagnosis of rheumatoid arthritis certain at this time?

Dr abby
Customer: replied 5 years ago.
I just got the dx on Wednesday from my Oncologist/hemotologist that treated my mother for the same illness.(Her father,my grandfather had it also as did another of his grandchildren-my cousin) I have not yet gone to a rheumatologist, but know that I must. I need to go through channels and get it authorized by my insurance before I see a specialist.
Thank you for clarifying,

I am sorry that you are in so much pain.
The reason that I ask whether the diagnosis is confirmed is because early treatment with certain types of medications is very important in rheumatoid arthritis.

No matter what stage a person is at (early or late in the disease), it is recommended that disease modifying antirheumatic drugs (called DMARD's) be started as soon as possible.
There are two classes of DMARD's-non-biologic and biologic--Enbrel being a biologic.
Non-biologics include methotrexate, among many others

There are side effects to all of these medications--your concern with immunosuppression with Enbrel is a valid one but the benefits typically far outweigh the risks if you have RA. Other side effects with Enbrel that are more common include headache and upper respiratory symptoms.

Voltaren gel can still cause some anticoagulation and is not recommended for people who have vonWillebrand's disease, unfortunately...

For now, narcotic pain relief is the route you will need to go until you can be accurately diagnosed and started on the correct antirheumatic drugs. Pain patches may work better for you as they give a steady dose over a period of time.

Please feel free to ask any follow up questions you may have,

Dr Abby

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