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Suffering From Rheumatoid Arthritis. Undergone Bilateral THR. Diagnosed Gluten Intolerant. Gained Weight. Suffer Fatty Liver. Solution?

Posted on Wed, 25 Sep 2013

Question: I am 49 years old, suffering from RYeumatoid arthritis since the age of 11, with deformities of the extremities.HAd undergone bilateral THR three years back and for full one year I had completely forgotten the name of PAIN.Since I am back to work, am a XXXXXXX economist, involved in sedentary tpe of desk work.My probem is unmanageable weight 78 kg, up from 37 kg in 1997, when I was diagnosed gluten intolerant. I am on methotrexate 10.5 mg a week.Scan revealed enlargement of liver as well as fatty liver. Can it be attributed to methotrexate. What should I do about the weight which is concentrated around abdomen.

Answered by Dr. K. Naga Ravi Prasad (1 hour later)

Brief Answer:
Hepatomegaly can be attributed to Methotrexate.

Detailed Answer:
Hi, thanks for writing to XXXXXXX

Yes, definitely Methotrexate can be attributed as a cause for your Hepatomegaly (enlarged liver). Methotrexate toxicity with regard to the liver has been established by many clinical trials and evidence based data is present about the same. So, it is customary to take Folic acid supplementation along with methotrexate to minimize its adverse reactions and systemic toxic effects.

Regarding your weight which is concentrated around the abdomen, I suggest you to consult a Plastic/Aesthetic surgeon for further workup and management.

Hope I have addressed your issues. Happy to help further.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (55 minutes later)

Thanks Doc fr the quick response.

I have started taking udiliv . Do you think it is going to help with the abdominal bloating. They say most of the weight related problems are associated with stress. Can I take some stress reliever?

I have learnt that you are an orthopaedic surgeon.Can I have some rough idea about the life f the implant.....on an average of course

Poonam
XXXXX

Answered by Dr. K. Naga Ravi Prasad (14 minutes later)

Brief Answer:
Udiliv may decrease abdominal bloating.

Detailed Answer:
Hi Dr XXXXX(Ursodeoxycholic acid) may have a positive effect on abdominal bloating.

Taking stress relievers may decrease your stress levels and may retard your further weight gain but they will not have any impact on the already existing body weight. So, in my opinion Aesthetic surgery will be an option for you.

The survivorship of a total joint implant (with well performed surgical technique) will be around 15-20 years.

Hope I have justified your query. Good day

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (15 minutes later)

Thanks for the prompt reply!
What kind of surgery you are referring to? Bariatric surgery or balooning, I have heard of. With my sorry state of health, I wonder I can undergo any kind of surgery, particularly the ones with so many known side effects.

I was thinking of trying SCD Specific carbohydrate date. What's your take on it?

Thanks in anticipation of your response as I guess its the last time I can communicate.

Thanks

Answered by Dr. K. Naga Ravi Prasad (51 minutes later)

Brief Answer:
Liposuction may be a better option.

Detailed Answer:
Hi, As far as my knowledge goes, Liposuction may be a better option to treat localized obesity. Bariatric surgery is indicated for generalized weight loss. Infact, any surgery will carry its own pros and cons. So, one has to weight the risk-benefit ration while undergoing a surgical procedure.

To be honest, I am clueless on Specific carbohydrate diet.

Take care and Good luck.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar