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Arthritis (Expert Forum)
Arthritis Meds Liver Disease
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
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Arthritis Meds Liver Disease
by mcrow, Nov 28, 2004 12:00AM
My 77-year old grandmother has chronic, severe Osteoarthritis and was diagnosed 2 years ago w/end stage Cirrhosis. Her liver disease has responded well to treatment (no alcohol, restricted protein/salt and diuretics). I have 2 questions...
1. Early on in her liver diagnosis, her liver doc gave her a year to live and her transplant doc was pushing for a transplant which she opted not to have. But she seems to be doing fine vis a vis the liver issue. If she continues w/her diet and meds and no alchohol - should the liver disease not be a factor in her future health? In other words, is she stable w/respect to the cirrhosis?
2. Years ago she tried and abandoned Vioxx/Celebrex as her stomach couldn't tolerate these meds and she wasn't able to keep them down. Now, because of the liver disease, she can't take oral painkillers. Last year her arthritis doc prescribed painkillers knowing she had liver disease, and she went into liver confusion, then full-on liver and kidney failure. She survived and then started a Lactulose regimin.
She's seeing a pain managment specialist, but nothing's working. In my opinion, her pain level is @ a "10" (she uses a walker)and she's getting pain therapies that deliver a "2" in terms of relief (physical therapy, a device that delivers some sort of electrical charge, accupressure). Is it possible she could have heavy-duty pain meds delivered via a shunt that would by-pass her blood-stream? I am concerned that the pain management specialist doesn't know enough about liver disease to be able to be as effective as possible and my grandmother is too freaked out about the liver confusion to push for anything substantive.
If the answer is that this is just one of those Catch-22s in medicine (what will help the arthritis will hurt the liver disease), I am willing to hear that there's not much to be done. But we'd love to go for a solution if there is one. Money and distance are no object. Many thanks.
1. Early on in her liver diagnosis, her liver doc gave her a year to live and her transplant doc was pushing for a transplant which she opted not to have. But she seems to be doing fine vis a vis the liver issue. If she continues w/her diet and meds and no alchohol - should the liver disease not be a factor in her future health? In other words, is she stable w/respect to the cirrhosis?
2. Years ago she tried and abandoned Vioxx/Celebrex as her stomach couldn't tolerate these meds and she wasn't able to keep them down. Now, because of the liver disease, she can't take oral painkillers. Last year her arthritis doc prescribed painkillers knowing she had liver disease, and she went into liver confusion, then full-on liver and kidney failure. She survived and then started a Lactulose regimin.
She's seeing a pain managment specialist, but nothing's working. In my opinion, her pain level is @ a "10" (she uses a walker)and she's getting pain therapies that deliver a "2" in terms of relief (physical therapy, a device that delivers some sort of electrical charge, accupressure). Is it possible she could have heavy-duty pain meds delivered via a shunt that would by-pass her blood-stream? I am concerned that the pain management specialist doesn't know enough about liver disease to be able to be as effective as possible and my grandmother is too freaked out about the liver confusion to push for anything substantive.
If the answer is that this is just one of those Catch-22s in medicine (what will help the arthritis will hurt the liver disease), I am willing to hear that there's not much to be done. But we'd love to go for a solution if there is one. Money and distance are no object. Many thanks.
Doctor's Answer
by Kevin Pho, MD, Nov 29, 2004 12:00AM
, Nov 29, 2004 12:00AM
This is a tough scenario, since many pain medications do affect the liver, and it seems like your grandmother is pretty sensitive to this.
You can try some topical medications - like a Lidoderm patch. Although it does get metabolized by the liver as well, the levels may be lower than with oral medication. However, if this isn't an option, I'm not aware of a pain medication that completely unaffect the liver.
Regarding the cirrhosis, it is generally irreversible in advances stages. Determine when this is would vary from patient to patient. Unfortunately, liver transplant would be the only definitive treatment of this disease.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
You can try some topical medications - like a Lidoderm patch. Although it does get metabolized by the liver as well, the levels may be lower than with oral medication. However, if this isn't an option, I'm not aware of a pain medication that completely unaffect the liver.
Regarding the cirrhosis, it is generally irreversible in advances stages. Determine when this is would vary from patient to patient. Unfortunately, liver transplant would be the only definitive treatment of this disease.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
You seem to think that drinking caused the liver damage?
However, there is a chemical with a lot of ethanol components
www.valdezlink.com/same.htm that does cause liver and kidney damage sometimes ... but glands and hormones are off; central nervous system damage. The joints and arthritis, too.
It seems to be an autoimmune imnmune system attacking the person.
Stop that. And the pain should cease; that's my theory.
It may not be that hard to do; someone has to have a cure out there, but maybe it wasn't popular to bring it forward
www.valdezlink.com/acute.htm
http://home.gci.net/~blessing/pages/seekinghelp.htm
Why I looked into this chemical in the first place:
http://home.gci.net/~blessing/pages/who.htm
I think all you have to do is find a doctor who is interested in looking into a little more in the blood. Most doctors are not interested, from what I'm finding.
Did grandma have flu-like symptoms at some point prior to this?
Does she have Chronic Fatigue Syndrome OTHER symptoms, too?
http://www.valdezlink.com/pages/howtotell.htm