Rheumatoid Arthritis Support Group
Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...
Well I had a rough week last week!!
This ended up being mostly a preventative measure for me but it was serious none the less. I am on Simpoin and Methotrexate. As we all know this leaves us as a sitting ducks for infection. I rarely get infections and have been very lucky over the last almost 20 years. But when we get an out-of-the-blue infection it is cause for alarm.
On Monday I noticed a red swelling on the inside of my upper arm. Not the lymph node area of my arm pit but the middle of the inside of my upper arm. I thought maybe I banged it or something. No biggie. On Tuesday it was bigger and redder.
I showed Jon and he said GO TO THE DOCTOR. I went to work with the promise that if it got worse I would go to the doctor. It did get worse.
I showed my co-worker to ask her what she thought. She said GO TO THE DOCTOR. So I was able to get a nurse triage appointment and headed in. The nurse was baffled and my wonderful PCP came in to take a look and said that it was cellulitis. An infection of the skin and dermis itself. Normally is starts with a break in the skin but it can happen, as in my case, without any cut or scratch in the skin -- I mean how do you cut the inside of your upper arm anyway?
Using a black sharpie she drew a dotted line around the margins of the swelling, prescribed antibiotics and sent me home with strict instructions to be very mindful of it and to stay in touch with her. I live out in the county and moderately rural.
The next day I stayed home from work just to be close to the doc if we needed to change our approach. She had told me that if this thing goes south, it will go south quickly. Work for me is farther OUT into the county and farther away from help. Before Jon left for work we drew a new dotted line with a blue sharpie this time to outline the new larger swelling.
My doc called that night for an update. I shared it with her and she said for me to get into the pharmacy for a new Super antibiotic called Zyvox. This new one would have serious interactions with my other meds but the risk was worth it in light of the greater risk. However, she said before I pick that up, she wanted me to pop into her office for a look-see. She said that she may just send me to the ER instead. That next morning I did a new dotted line in red sharpie and it was clear that two days of antibiotics hadn't affected anything. I went into the doctor's office and she sent me to the hospital.
Over at the hospital in triage they looked at the new dotted line and the swelling was well beyond that. It now encompassed my inner upper arm and then wrapped around my elbow and involved my forearm. It was really weird! Again all with no wound of any kind. They gave me IV antibiotics (nurses LOVE my veins -- LOL). The doc came in and said that he thought I would be fine but he wanted to keep an eye on me and that I would be checking into Sky Ridge hospital. Darn it! HOWEVER, knowing this was a distinct possibility, I had already packed an overnight bag and had clean jammies, toothbrush and deodorant. I didn't want to burden anyone with fetching and getting for me so I planned ahead. I brought a good book and my phone charger too.
Anyway, I got all checked in, got checked on regularly by the nurses and was BORED to tears. Jon brought our joyous Golden Retriever in to see me -- they let any dog in to visit -- how wicked cool is that!! A couple of other friends came too. I ordered a guest meal for Jon so we had supper together and then being the awesome guy he is, he brought me REAL coffee the next morning. They administered another IV dose of antibiotics 24 hours after the first dose and cut me loose with instructions to monitor it and to finish taking the original oral antibiotics that I started on. My rheumatologist also chimed in and said to NOT take the methotrexate shot until I was totally done with the antibiotics. While it is a very nice hospital, there is no place like home!
No telling when and if this will happen again. I have an appointment to see my rheumatologist on the 3rd anyway, so we will talk about my meds then. We will probably stay on the same regimen but with a watchful eye. If this all happens again, we will have to rethink things but there are not that many options out there.
Has anyone else ever dealt with this? I learned that a normal healthy co-worker almost lost her foot to it and that it killed her father. AND get this, I am the director of Planning for our county and the evening following my very first Dr. appointment for this I had a planning commission meeting to attend. One of my planning commissioners (a normal, healthy guy) shows up with a bandaged hand. I asked what the heck happened and he said he had emergency surgery the day before because of cellulitis! He too had no cut or wound of any kind! That, the very same day I am diagnosed and I had never even heard of it before!
This ended up being mostly a preventative measure for me but it was serious none the less. I am on Simpoin and Methotrexate. As we all know this leaves us as a sitting ducks for infection. I rarely get infections and have been very lucky over the last almost 20 years. But when we get an out-of-the-blue infection it is cause for alarm.
On Monday I noticed a red swelling on the inside of my upper arm. Not the lymph node area of my arm pit but the middle of the inside of my upper arm. I thought maybe I banged it or something. No biggie. On Tuesday it was bigger and redder.
I showed Jon and he said GO TO THE DOCTOR. I went to work with the promise that if it got worse I would go to the doctor. It did get worse.
I showed my co-worker to ask her what she thought. She said GO TO THE DOCTOR. So I was able to get a nurse triage appointment and headed in. The nurse was baffled and my wonderful PCP came in to take a look and said that it was cellulitis. An infection of the skin and dermis itself. Normally is starts with a break in the skin but it can happen, as in my case, without any cut or scratch in the skin -- I mean how do you cut the inside of your upper arm anyway?
Using a black sharpie she drew a dotted line around the margins of the swelling, prescribed antibiotics and sent me home with strict instructions to be very mindful of it and to stay in touch with her. I live out in the county and moderately rural.
The next day I stayed home from work just to be close to the doc if we needed to change our approach. She had told me that if this thing goes south, it will go south quickly. Work for me is farther OUT into the county and farther away from help. Before Jon left for work we drew a new dotted line with a blue sharpie this time to outline the new larger swelling.
My doc called that night for an update. I shared it with her and she said for me to get into the pharmacy for a new Super antibiotic called Zyvox. This new one would have serious interactions with my other meds but the risk was worth it in light of the greater risk. However, she said before I pick that up, she wanted me to pop into her office for a look-see. She said that she may just send me to the ER instead. That next morning I did a new dotted line in red sharpie and it was clear that two days of antibiotics hadn't affected anything. I went into the doctor's office and she sent me to the hospital.
Over at the hospital in triage they looked at the new dotted line and the swelling was well beyond that. It now encompassed my inner upper arm and then wrapped around my elbow and involved my forearm. It was really weird! Again all with no wound of any kind. They gave me IV antibiotics (nurses LOVE my veins -- LOL). The doc came in and said that he thought I would be fine but he wanted to keep an eye on me and that I would be checking into Sky Ridge hospital. Darn it! HOWEVER, knowing this was a distinct possibility, I had already packed an overnight bag and had clean jammies, toothbrush and deodorant. I didn't want to burden anyone with fetching and getting for me so I planned ahead. I brought a good book and my phone charger too.
Anyway, I got all checked in, got checked on regularly by the nurses and was BORED to tears. Jon brought our joyous Golden Retriever in to see me -- they let any dog in to visit -- how wicked cool is that!! A couple of other friends came too. I ordered a guest meal for Jon so we had supper together and then being the awesome guy he is, he brought me REAL coffee the next morning. They administered another IV dose of antibiotics 24 hours after the first dose and cut me loose with instructions to monitor it and to finish taking the original oral antibiotics that I started on. My rheumatologist also chimed in and said to NOT take the methotrexate shot until I was totally done with the antibiotics. While it is a very nice hospital, there is no place like home!
No telling when and if this will happen again. I have an appointment to see my rheumatologist on the 3rd anyway, so we will talk about my meds then. We will probably stay on the same regimen but with a watchful eye. If this all happens again, we will have to rethink things but there are not that many options out there.
Has anyone else ever dealt with this? I learned that a normal healthy co-worker almost lost her foot to it and that it killed her father. AND get this, I am the director of Planning for our county and the evening following my very first Dr. appointment for this I had a planning commission meeting to attend. One of my planning commissioners (a normal, healthy guy) shows up with a bandaged hand. I asked what the heck happened and he said he had emergency surgery the day before because of cellulitis! He too had no cut or wound of any kind! That, the very same day I am diagnosed and I had never even heard of it before!
I first learned of it when my boys were small. My son was diagnosed with it one his finger and another time on his eye. My other boy, on his foot. One of those times, there was no cut. Last year, my father had a very serious case of cellulitis on his hand. It was so aggressive that they finally had to culture to identify the bacteria. It was from the soil and had gotten into a small cut he didn't know he had. They used very strong antibiotics then too.
I appreciate the reminder to be mindful of this type of infection. I hope you continue to heal and feel better.
thinking of you and rooting for you
depot
This was long before I had even heard of methotrexate, though, and the biologics weren't even invented yet. This may have happened to you even without the RA drugs.
That's so cool that your local hospital allows dogs! I'm going to Colorado next time I need a hospital.
I have had it several times over the years but only in my lower legs and forearms. Should I suspect cellulitis now I head straight to my PCP
for strong antibiotics.
\I hope it has cleared up for you now. I am sure many people have never heard of it so thank you for sharing your experience.
On a good note, it is clear that the addition of methotrexate to my Simponi IS WORKING. Now that can't take it until the antibiotics are done....oooo the pain is pretty bad. So that is a silver lining. I always like it when I know that a medication is working and worth it.
I wish I could.post a picture of my dog with me on my hospital bed...that have to sanitize it anyway! LOL
In all the reading I have done the onset of RA is oftentimes attributed to a combination of: 1) genetic predisposition 2) an infection of some sort (sometimes totally unnoticed) and 3) an external stressor (could be an emotional stressor or a physical injury). It is sort of like the proverbial "planets line up" and all of these things are at the "wrong place at the wrong time" and BAM! you have RA (or myriad other autoimmune diseases).
I got the RA genes from papa who had AS. I am not aware of any infection at the time -- but not inconceivable and at the time I had a pretty serious emotional roller coaster going on...Also recent study showed that regular but MODERATE alcohol consumption reduces the risk of developing RA!! Geez. I quit drinking in my early 20s as moderation wasn't something I was very good at... So who knows? The other VERY interesting factoid for me is that I decided to "try" drinking again about 8 years ago. The ability to drink moderately was not in my wheel house so that didn't last very long and I quit again in totality. BUT during that time I had ZERO RA symptoms and was on no RA meds at all. I even did a triathlon and worked 60 hours a week -- no meds at all! Crazy huh?
Within a week of stopping alcohol, my knees were so heavily involved that I could not get out of a chair that didn't have arms because I needed to use MY arms to help lift myself out of the seat.