Non-steroidal anti-inflammatory drugs (NSAID)

Advice required regarding Voltarol/Diclofenac sodium

11 messages
20/06/2005 at 19:20
Hi,

With regards to the thread title and description I am after some much needed advice from anyone in the know.

Just before Christmas I was referred to my GP by my Osteopath for an inflamed back with chronic lower stiffness and bad sciatica. A blood test highlighted that:
i. My thyroid was underactive.
ii. My ESR was high.
iii. My CRP was positive.
iv. Rheumatoid factor was present.

My GP advised me to wait 4 weeks and have the tests repeated. The test results were almost identical.

I was prescribed levothyroxine for the thyroid and 50 mg Voltarol (Diclofenac sodium) 3 times a day and referred to a Rheumatologist for suspected rheumatoid arthritis.

The Voltarol has been a miracle. Resolved the back/sciatica issues in no time at all.

The Rheumatologist took my case history and had me stretch every which way. More blood tests and back x-rays. He concluded my range of movement was above normal, the blood test and x-rays have all came back clear/normal.

He advised me to come off the Voltarol/diclofenac sodium which I have. The back/sciatica problems have returned with a vengeance within a few days of reducing the dosage.

The question I ask (to anyone in the know) is that I understand that the anti-inflammatory drugs work by stopping the body from producing the flammatory's. Therefore, while taking the 3 times a day dosage of Voltarol/Diclofenac sodium a blood test would show a "clear/normal" result or not?

I have been completely off the Voltarol/Diclofenac sodium for 3 weeks now. My GP wants me to have another blood test for the inflammatory markers in another weeks time to see if they have returned.

It just feels like Ground-hog day all over again. And the running, that has had to stop due to the chronic sciatica.

Can anyone shed any light/advice on the above.

Many thanks.

Sean.
20/06/2005 at 22:31
mmmm...I've had the sciatic symptoms but not the others, which may (or may not) be significant. Fwiw, my opinion is....

...Voltarol has been pretty good for me too in the past month - my sciatica had also got so bad I'd had to stop running.

I am, however, just coming to the end of my 28-day supply. Have rather mixed feelings about this following the recent headlines about NSAIDs (including Voltarol) and heart attack risk.

Quite apart from that, I wouldn't fancy taking the stuff long term in view of what it can do to the stomach lining - allows it to be attacked by the stomach acid.

At the suggestion of Welsh Poppy (see Training), I've invested in some Bromelain tablets (from Holland & Barretts) - these are supposed to have anti inflammatory properties also. Maybe something to consider?
20/06/2005 at 23:22
Thyroid, ESR and CPR results could all be related. Rheumatoid factor can be an indicator of several different autoimmune diseases, and a number of conditions or infections. So sounds like GP is just trying to figure out which one is causing ur symptoms and whether ur symptoms/results stem from one problem or more than one. Back probs may be completely unrelated to thyroid and if so it's lucky u went to docs, things could have gotten lot worse if it had went undiagnosed. It may be if they get ur thyroid meds right the back probs will go, could be what GP is testing out at the moment.

I'm not an expert though, just have a lot of family members with thyroid probs and Psoriatic Arthritis so know it's a bit of a minefield and mainly down to trial and error.

Good Luck, and talk to ur doc don't suffer in silence go straight back and tell them pain has returned.
20/06/2005 at 23:25
Another bit of advice I'v learned from my family is annoy the hell out ur doc. The patients who shout the loudest get treated first.
20/06/2005 at 23:33
Velociraptor is a doctor I believe so you may be able to get some advice from her if you can track her down on a thread. ;0)
20/06/2005 at 23:57
Hi Sean

Tangerinetwirly is spot on, I think, in that your GP is trying to figure out what's causing what. Your test results are not unusual for someone with an untreated thyroid condition.

Did your GP run thyroid antibodies tests to establish if you have Hashimoto's (the autoimmune variety of thyroid underactivity). It doesn't change the treatment but it's useful to know as it can mean a slightly higher risk of developing other autoimmune conditions (like RA).

As far as the Diclofenac is concerned, it's probably best to be off it. NSAIDs are known to affect thyroid function in different ways depending on which type. In particular, Diclofenac increases free hormone levels by interfering with their binding to serum proteins, so while you're taking Diclofenac, your thyroid hormone tests may look (artificially) better than they actually are. Here are a couple of refs (sorry, don't do links!):

http://jcem.endojournals.org/cgi/content/full/88/12/5710

http://www.thyroidmanager.org/Chapter5/5a-frame.htm

I'd also agree with TT on shouting loudly. TD is a condition that the NHS doesn't seem to deal with very well, so my advice would be educate yourself as much as poss and be assertive. Hope this helps.

21/06/2005 at 19:29
Many thanks for thoughts and opinions, they are all very welcome.

Personally, I think the thyroid and sciatica/lower back issues are unrelated to a point. However, they may both be auto-immune disease related. I do feel that my thyroid is pretty much in check now.

Its the sciatica/lower back that is really causing me the problems. Severe sleep depravation etc.

The Rheumatologist thinks the problems are mechanical. I spent the 6 months prior to seeing my GP for the initial blood tests seeing Osteopaths, Chiropractors, Physio's and then back to the Osteopaths thinking it was mechanical but they all concluded it was not mechanical.

I will be having a new blood test next week and then I will see my GP a few weeks after for the results. I will not suffer in silence - I wrote to my Rheumatologist as soon as the pain returned. He responded by having my x-rays double checked but still "essentially normal". Next appointment with him is in Nov 05.

No, my GP never checked to see if the thyroid was caused by Hashimoto's disease.

Its taken me 5 months to get my running back to pre-problems and now I'm going back a square one!

Still, there is always someone worse off than myself.
21/06/2005 at 19:35
has the Consultant referred you to the Rheumatology physios- they may be able to assess your back to see if it is a mechanical problem in the light of you potentially having other problems rather than seeing the mechanical /and or rheumatological problems separately
21/06/2005 at 19:42
Buney, no the only "way forward" with the Rheumatologist is a come back in November and we'll see whats happing then.

I will be knocking on my GP's door in a few weeks time to see what THEY are going to do.
21/06/2005 at 19:51
Many thanks for thoughts and opinions, they are all very welcome.

Personally, I think the thyroid and sciatica/lower back issues are unrelated to a point. However, they may both be auto-immune disease related. I do feel that my thyroid is pretty much in check now.

Its the sciatica/lower back that is really causing me the problems. Severe sleep depravation etc.

The Rheumatologist thinks the problems are mechanical. I spent the 6 months prior to seeing my GP for the initial blood tests seeing Osteopaths, Chiropractors, Physio's and then back to the Osteopaths thinking it was mechanical but they all concluded it was not mechanical.

I will be having a new blood test next week and then I will see my GP a few weeks after for the results. I will not suffer in silence - I wrote to my Rheumatologist as soon as the pain returned. He responded by having my x-rays double checked but still "essentially normal". Next appointment with him is in Nov 05.

No, my GP never checked to see if the thyroid was caused by Hashimoto's disease.

Its taken me 5 months to get my running back to pre-problems and now I'm going back a square one!

Still, there is always someone worse off than myself.
21/06/2005 at 21:44
Sean,

I hope things get sorted with the thyroid.

I have been on several different pain killers / anti inflammotories over 14 years (shoulder injury). I've been on the naproxen (approx 7 years) and diclofenac approx 6 - 12 months - my Dr's refused to allow me to have another prescription. I did try Voltarol but that made me very ill!

Turmeric was recommended as an anti-inflam, you can get it in health shops, I've been on that for around 4 - 6 months now, I have been in a bit of pain recently so I've increased my doseage from the minimum of 1 to a maximum of 3 per day until this eases up. However, I would also suggest that you ask a Dr if it's safe to take with the drugs your on for the thyroid in case of complications.

As others on the thread have said, you've got to shout at the Dr's, unless you do that I'm afraid you'll be at the end of the queue and forgotten about. I didn't shout at mine enough, I got annoyed and got referred to a specialist by work's Dr; he told me in no uncertain terms that I needed a shoulder operation immediately to repair damage.

Fair play with your attitude on someone else is always worse off - that was mine too, but I can sympathise (as many others here will too) if your unable to run etc.

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