Just a quick question

Sure, this has happened to me off and on since I was diagnosed 20 years back. Even on meds that seemed to control the inflammation I would go through periods of extreme fatigue. I sometimes think that the meds are actually the cause of this sine many of them alter things on a cellular level to control the disease.

One thing you might ask about is anemia. I was having very bad periods of fatigue and after running some tests it was found that I am anemic now. I guess it can be quite common with people who have RA. I take an iron supplement as well as try to eat iron rich foods and that does seem to help most of the time.

I hope you find some relief and that your new meds work. Take it easy and hang in there :)

Fatigue is a big part of RA (or any autoimmune disease for that matter), but could be in part related to the Rituxan as well. As Don suggests, many people with RA also have anemia, Rituxan can worsen this. I presume that your rheumatologist is monitoring your blood work routinely, so new or worsening anemia should be caught promptly and addressed.

I also take Rituxan (along with MTX, sulfasalazine, prednisone, Plaquenil and others) and find that I have a good deal of fatigue following infusions despite receiving 200mg of solumedrol and 10mg of dexamethsone (steroids) with each. I break out in blisters and hives, and get rigors during the infusions, so I tend to get more steroids than some people.

Luckily, I was aware that this was a possibility before I started Rituxan, so I was not alarmed. I am also a former heme-onc RN prior to moving to critical care several years ago, and have given Rituxan a thousand times to patients with lymphoma, so I was pretty familiar with the side effects before I got my first dose. Most people notice fatigue after receiving Rituxan. Dizziness, weakness, and nausea are also pretty common, although some people are lucky and completely escape the nausea. Bone pain and flu-like symptoms are quite common post infusion as well.

I try to schedule my infusions around my work schedule. I find that the nausea kicks in about day 4 -5 for me and persists for a couple of weeks and then lets up. The fatigue is bad the first week as well, but gets better (at least for me) after the first week. The 2 days following infusion, I have pretty bad bone pain and lots of trouble sleeping. Low grade fever is common, and I have this as well. about a week after infusion, I am able to go back to work, although the 13 hour shift is a long one for me now. Never use to be, but after RA it is. I am only 45 and was an avid runner before RA. But things change, and I consider myself lucky to still be able to do a job that I love.

I hope this finds you feeling better. Good luck with your next infusion. If you have excessive fatigue or bleeding, bruising more than usual, make an appointment with your rheumatologist.

Ask your RA doc about bloodwork to check for anemia, since it is so common with an RA condition, I get anemic as well...and I only take mtx and I'm weaning off that...

Peggy,

Hope your infusion goes well. Keep an eye on that itching around the ears. This and a "tickle in the back of the throat or sore throat" are often the first sign of reaction. If treated quickly (steroids, benadryl and and stopping the infusion for 30 min and restating at a lower rate) are often effective in stopping symptoms. Most people do better with subsequent infusions. The first is usually the roughest in terms of infusion reaction. I did not get the blisters with my second infusion. It went a little quicker as well. Like 5 hours as opposed to eight.

I had a little more bone pain post infusion with my second one and flu-like symptoms. I just plan on not doing anything for a few days post infusion. I do all my housework pre-infusion. I work overtime pre-infusion because I know I will a need about a week to return to work. Working the trauma bays for 13 hours a day is too taxing after Rituxan.

IT's important to know your limits. Gone are the days of running 10 miles after my 13 hour shift, and doing Tae Kwon Do with my boys. Now it's more like work and come home and go to bed. But it is what it is, and I am lucky to be able to work. When I was first diagnosed, I could not get up the stairs in my house. I had to use the handicapped bathroom stalls when I was out. I have found MTX and Rituxan to be very beneficial. I am lucky that my employer is very supportive. I have a supportive spouse and kids. This year, I was able to hike the Waipio Valley on Hawaii with my family. I attribute this change to good treatment for the RA. I about died hiking out of the valley on the 25% grade, when 2 years ago I could have jogged up that trail, but...hey it's better than it was.

Oh...I also had jaw and tooth pain (likely along the facial nerve path). This has been documented in other patients. Another weird effect that I got from both MTX and Rituxan was a major change in my hair. I was born a blonde with straight hair. Now I am a redhead with curly hair. Not complaining, but it is strange. Small trade offs for a better overall life, in my opinion.

Fortunately, depending on how well Rituxan works for you, you only have to do it every 6-12 months. Some people do every 4, however; I find the risk of significant immunosuppression to be too high to be acceptable for me to take it this often, especially in my line of work since I am exposed to illness/infection every day at work.

If Rituxan works for you, you should notice benefit with a couple months. It is not immediately effective, and for some people, does not work. I hope you find it beneficial. Good luck.

Still trying to make some lemonade out of these lemons....

Stacey

Stacy I got my infusion yesterday all went well. Came home and went to bed got plenty of rest. Today is a bad day. For some em reason my back is gone crzy. It has a catch in it and it will take my breath when I move certain ways. It's really rough. Could this be from the Infusion. This didn't happen last time. I hope you can shed some light for me since you are so familiar with this drug.
Thanks
Peggy

Peggy,

Glad your infusion went well. Hope you are feeling better. Had to take off for Phoenix for a few days, my mom has ms and it's hard to live so far way.

Anyhow. . I'm not sure about the hair. I still have to color my grey. I wish the Rituxan had changed that. Lol. Sadly, the grey has been resistant to any change. :)

Trying to do this from my smart phone (which I am not good at) so hopefully I don't come if sounding like an idiot. Lol. :)