New BC diagnosis with existing RA disease

Hi Golfnut33,

I am so glad to hear from you. Based on what you shared it seems like you're just starting this BC journey as well. I'm sorry to hear that you have to go back for another lumpectomy to get clear margins. How long do you have to wait between surgeries? The breast surgeon that I have did warn me that that could happen to a patient but it sounded like it wasn't afrequent occurance. I'll be having my lumpectomy in just a few days and I'm already stressed because I can't take ibuprofen now and the pain is building especially with making walking miserable. I'm recovering from a total knee replacement that I had a couple of months ago so I still have some inflammation from that as well.

I had my first meeting with all my doctors last week to hear what kind of plan they all decided for me based on the mammogram and pathology reports. The team consisted of the breast surgeon, medical oncologist, and radiologist. I had left encouraged hearing that the cancer was in the earliest stage and apparently noninvasive at the present time.The medical oncologist informed me that he could use a drug called Anastrozole to block the estrogen and progesterone receptors, so that was the good news. The bad news was that one of the side effects of this drug is that it causes joint pain. I am not eager to hear this news and will consult with my trusted rheumatologist next month.

I have discontinued my Humira but still take methotrexate and the folic acid. I'm okay with giving up the Humira if he thinks that that had contributed breast cancer but I wonder if he'll have anything in its place to offer. Like you, I worry about the effects of giving up Humira up will have on my body. I have so much chronic pain most days that I no longer can enjoy going for walks or other activities that I enjoyed doing on a regular basis. Because our arthritic diseases are not curable but hopefully controlled with medication, we can only hope that a plan can be formulated to work together to control these conditions. Is ADH another medical condition that you need a special doctor for?

Just looking ahead to the radiation aspect of treatment for this DCIS, are you concerned about being a methotrexate and having radiation to skin that can burn more severely because of this medication? I'm discovering that there is so much to think about with this new diagnosis and many questions pop up as I read about other people's experiences.

Please keep me posted on how you are progressing. Best of luck with your next lumpectomy.

Hi Labmom82,

I was on Humira for about 5 years but was taken off as soon as I told my Rheumatologist about my BC. I wasn't too upset at the time because I was trying to tell him that I didn't think it was working as well as before but my lab tests were normal he said I should continue. I was also on Methotrexate also and was told to continue just with that with a slight dosage increase. I went through 20 weeks of radiation but had a quit Methotrexate as well because there can be increased burning while on it. I finished my treatments in October and went back on MTX afterward but I was flaring more in neck, shoulders, knees. feet and ankles. My RA doc didn't offer Prednisone because probably because of a recent total knee replacement and risking infection. All I know is that being off my biologic for 3 weeks for surgery and then off MTX for a month for radiation helped to increase widespread pain issues. A few weeks ago I was put on a DMARD medication called Leflunomide to trial that until I see him in 3 months. About the same time I started taking Turmeric because of it anti inflammatory properties (I cleared it with my RA doc first) but I can't tell much of a difference yet. I was told it could take up to 3 months to feel any effects of the Leflunomide. I would take Ibuprofen sparingly for pain but after read the drug information I am afraid to.

I sometimes get discouraged because of the pain issues and how RA has changed my life and then have that compounded with a BC diagnosis besides. This site has so much information and support regarding breast cancer but it is difficult to find much on the internet regarding both diseases together and what to expect.

I wish you well with you radiation treatments and hope your doctor gets you off the Prednisone soon and maybe offer another solution. I, like you,dread being on prednisone but sometimes it is needed and it helps get thru the difficult days.

How is Tamoxifen working out for you? I was offered Armidex at first but didn't want to start that after reading about the joint and muscle pains side effects and many comments on the forum here. Then my MO offered Tamoxifen but that scares me as well. I did see an article that it could be effective at a lower dose so I may approach him about it next visit. I am very cautious right now with meds.

Let me know how your treatments goes.

Hi Candy,

I am sorry to hear of your pain issues and the lack of communication between your doctors. I am curious why your MO said no to MTX. My situation is different from yours in that I am not on hormone therapy and my MO said being on MTX would be okay for me. If your MO said not to use MTX than he should call your RA doc to explain why you shouldn't be on that medication and they should find what else might work instead. Your MO is the one wanting to discontinue your RA med but needs to talk with that doctor to find out what they might be able to offer you instead to keep you from going into a flare and to manage daily pain issues. I would encourage you to talk with your MO again and tell him you would like him to call you RA doc because you are suffering in pain because you are not on any RA meds. Or turn it around and have the RA doc call the MO, which ever might give you the outcome you need.

I was taken off my biologic when diagnosed with BC but left on Methotrexate. I was worried what that would do to my so when I had my first multidisciplinary meeting with my cancer doctors, I mentioned to each of them individually that I wanted to them to keep my RA doc in the loop. It was important to me because I didn't want to have my RA get out of control.

When I met with the RO for the first time I mentioned my concern about starting radiation while on MTX. He agreed that I should be off it during treatment. I asked that he contact my RA doc to discuss it with him and he agreed. The day before I was to start radiation I asked the nurse to speak to the RO to see what was decided. She went to talk with him and came back to say that he talked with my RA and they agreed that I should be off MTX while getting treatment. The problem was that neither of them got back to me to let me know, so I had taken my weekly dose a couple of days earlier. So in this case they communicated among themselves but left me out of the loop! I went back on the MTX after radiation but when saw my RA doc for a checkup and complained that I had widespread pain he discussed increasing my MTX to a point where I would go from pill to injectable form because of possible stomach/liver issues that could develop. I wasn't too keen on that idea so the next time I saw him he offered Arava to see if that might relieve my pain. This meant the I would stop the MTX because you can't be on both at the same time. I was told that it takes up to 3 months to feel the effects. It has been 6 weeks now and I have felt better for the was few days and am hopeful that maybe the Arava is working now for me but need more time to really decide if that is the case or not. I really blame my flare on the absence of RA meds and I am thankful that my Rheumatologist is willing to try something new. I don't see my MO much because I refused to go on Anastrazole that he chose for me because of the pain side effects that I have read about so he really doesn't have much to say about my RA drugs except that MTX should be good. On the other hand my RA doc agreed that Anastrazole can cause joint pain, but he didn't say if I should go on it or not.

I wish you nothing but the best and hope you get some relief soon. Keep us posted on what you decide to do.

Blessings to you.

Candy,

I agree with you that these two experts in their fields need to talk to find out what would be the best treatment for you. I think it would be a good idea to make the appt with the rheumatologist to discuss the medication possibilities considering your present BC status. Update him (or her) as to what is happening with your BC and let him know that your pain has become an issue and you need to know what his recommendation is for control of RA pain. When he tells you what his recommendation is then ask him if he would please discuss this with the MO. Your doctors need to have a clear understanding what you want from them. I realize that sometimes some doctors are easier to talk with than others, but give it a shot and go in prepared to discuss what is important to you. You are right that you don't know how long you have, but being pain free is one goal to have.

Best wishes and be strong.

Labmom,

Congratulations on finishing your radiation treatments despite your shoulder pain. It must have been difficult for you but somehow you made it through it all. I hope you get relief going back on Enbrel. It is nice that your doctors could agree to let you go go back on your RA medication. I wasn't allowed to go back on my biologic and instead got put back on a DMARD. I am not responding like I hoped I would but once I am on it for the initial 3 month period without problems, then I get bumped up in dosage. I am uneasy with being on RA meds and all its side effects but need to get the flares under control. Wishing you a speedy recovery.