Methotrexate Treatment and Back Pain
Hence today's blog post title, "Best laid plans ... you know how the saying goes!"
So as I sit here typing away on my blog, my lower back and lumbar area is supported by multiple pillows and a heating pad. In addition, I'm sitting on top of another layer of pillows including an orthopedic pillow to support the sacral joint. Lower back pain was one of the early symptoms I experienced prior to my lupus diagnosis, in my early 30's. I would blame it on my workout routine and thought I'd overdone it. Upon consulting an orthopedic specialist, the diagnosis of degenerative disk disease was made. On a fairly regular basis, my back would "go out on me" and I would be bedridden for days until treatment with NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) and muscle relaxers kicked in; and slowly, I'd return to the physical duties of my law enforcement career.
So for the past 17+ years, back pain has been an integral part of my life. However, this recent episode had a new twist to it. Last Saturday morning I woke up with shooting pain in my lower back, it was radiating throughout my hips and I was unable to get out of bed. The pain intensified every inch I moved as I attempted to engage my core muscles to sit up in bed or roll over to swing my feet onto the floor. I felt like a turtle on its back and completely helpless. I looked over at Giggles, my dog, for assistance. Well? Can you help me? She just burrowed her head into my side looking for her morning belly rub and chin scratch. I don't blame her, I would too. But, this particular day I was in distress. As I said before, this isn't completely foreign territory for me to be experiencing debilitating back pain. But, it is foreign to have a sudden onset before I even get out of bed. Usually, some sort of action or event would occur; such as, bending over to pick something up, twisting my torso, or just leaning over sink brushing my teeth. When the back goes out, all plans for the day go out the window and the focus becomes .... how do I stop the pain!
Every attempt to move was met with severe nausea, dizziness, abdominal cramping, alternating fever/chills and overall weakness in my extremities. It took over 30 minutes for me to maneuver my feet onto the floor. And it wasn't long before Giggles realized something wasn't right with her mom. She came over to my side of the bed and stood there until I could get up. I was able to use Giggles for support to make my way to the bathroom. I was mentally searching for what brought this on so suddenly and all the indicators pointed to one thing.... methotrexate.
I had received my weekly injection of methotrexate the previous day, on Friday. I was starting to see a pattern of symptoms every time I received my injection. I pulled out the prescription drug information sheet on methotrexate and also from Drugs.com. I was experiencing at least 10 of the side effects listed. Having this many side effects was definitely venturing into uncharted waters. Normally, I would experience a few symptoms after my injection... extreme fatigue, loss of appetite, nausea, headaches, etc.; but they would dissipate after 24 - 48 hours. This episode took over a week to dissipate and I still feel like I'm walking on eggshells to avoid a recurrence.
Follow-up Care
Definitely will be adding this to my list of concerns to discuss with my rheumatologist at the next appointment; which fortunately, is this coming week. Ironically, at my last appointment we discussed tapering down the dosage slowly; so as, not to produce a flare-up. When the drug side effects begin outweighing the benefits for the medication, it's time to reassess!
I have been on methotrexate treatment for over 17 years and can attest to its benefits! It kept me going when other drugs failed and I'm forever thankful for it. More importantly, it spared me from relying on prednisone for constant long-term treatment.
Every lupus patient has their own unique set of symptoms and thus their own unique plan for treatment. What works for one person may not work for another. But, I feel it's important to share my personal experience and journey to help another person make the right decision for his or herself. Please do your homework before entering into any lupus treatment. It's critical to your health that you do research and the proper due diligence; including, having a meaningful discussion with your doctor.
Just as lupus can keep us on our toes with it's unpredictability, so can the medications and treatments. Proper monitoring of a chronic disease such as lupus means having to adjust the treatment plan from time to time.
411 on Methotrexate
Methotrexate is in a class of drugs called DMARDs (Disease-Modifying AntiRheumatic Drugs). DMARDs work in stopping the inflammatory process that can cause symptoms and damage joints and internal organs in autoimmune types of arthritis, like lupus. Because of this process, methotrexate can reduce your ability to fight infections. It requires regular monitoring of blood and urine to check for liver and kidney toxicity. Methotrexate treatment is very inexpensive compared to other lupus treatments and must be taken with daily doses of folic acid. It is available in generic form (tablet and injectable), but needs to be closely monitored by your rheumatologist. Please refer to the Arthritis Foundations annual drug guide, Arthritis.org, for medication information and what you need to know for side effects and warnings.
I'll tune in next time and let you know how the doctor appointment goes. Now it's Nap Time!!!
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