silly question, how long does a herx last??

[Silvia]

Hello everyone:

about 3 days ago, my foot (the main focus of my RA) swelled dramatically, with corresponding increase in pain!! around the same time as I increased the mino from 100mg MWF to 100mg BID MWF.  I'm sure this is the wonderful world of Herx that everyone is talking about, so I'm happy that something is happening, but this is more pain than I've ever had with RA up until now.  I know I can't ask this question, because everyone is different, but I'm asking anyways- how long (ballpark) does herxing last?  I've had RA for 7 years, was on Enbrel and MTX for about 6 months, without results, stopped in May.  Started Mino in june 08, had IV clinda in July.  I can tolerate the pain (with a little help from tylenol 3), I would prefer not to lower the dose if I don't have to.  Also, I've been offered cortisone injections into the soft tissue of the foot, to alleviate the swelling/pain.  Any thoughts on this?

thanks a lot!    Silvia

[lynnie_sydney]

Silvia – my herx 5 years ago lasted about 6 weeks. However, I do not have classic RA and others find theirs is much longer. I am wondering why you doubled your dose? In any event, if it were me, I would choose to dial it back to the once a day MWF or maybe just add one day with the bid dose – versus adding cortisone into the mix. You may need to tweak a little to where you find it tolerable. And it is important that you DO find a dose that's tolerable. Lynnie

Be well! Lynnie

Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)

[linda]

Hi Silvia,

Lynnie is right, herxes are different for everyone. A lot depends on how long you've been sick and how many joints are involved. I'm concerned that you stopped your other meds, are you taking anything for inflammation? The antibiotics are not effective if there is too much inflammation around the infected tissue, so you need to be on some kind of anti-inflammatory.

As for the cortisone injections, they are a much better way to go than to take prednisone. The injection doesn't get spread thru the rest of the body as much as it does with prednisone pills. However, you do have to be careful where to get the injections. Avoid the achilles tendon at all costs, the cortisone can cause it (or any other tendon it's injected into) to rupture, which usually can only be repaired surgically. Otherwise, they're alright as long as you don't get them often as they will weaken the joint. Some people think they hurt, but if the doctor sprays liquid nitrogen (?) or whatever that stuff is that they use to freeze warts, on the area first, you won't really feel it. Usually there is lidocaine mixed in with the cortisone as well to prevent pain upon injection and afterward. As far as shots go, not really too bad, just don't look!:doh:  And they are usually quite effective for a few months. I wish someone would come up with some kind of transdermal patch with cortisone, for the smaller joints, so that we could avoid the injections and oral prednisone. There's probably some medical reason for why they don't use them, but they do make patches with lidocaine that can be worn for 12 hours, so I would think that a cortisone patch would be OK.  Anyway, good luck, and if you have any questions about steroids, let me know. Unfortunately, I have a lot of experience with them.

linda

[John McDonald]

Silvia,

The mino half life in blood serum is about 15 to 18 hours. If you let 3 or 4 half-lives elapse then you will have close to zero minocycline on board. If it is a herx, and it sounds like a classic herx, then a 2 day break should bring back some control. The idea is to kill the microbes, not the poor foot. This takes months. The best herx is one that is just tolerable.

[Lizz]

Silvia, get a cortisone shot, in the right spot , if you need it. Otherwise, how could you possibly walk, drive the car, etc.?? I've found that the shots are a lifesaver, and over time as you progress on AP, you'll need them less and less. What ever you do, avoid large doses of prednisone. This herx is a good thing, just do sensible things for the pain to keep going. All the best!

[Maz]

Hi Sylvia,

In addition to the suggestions above, thought you might be interested to read this section in the Physician's Packet (historical protocol) about intra-articular antibiotic and cortisone combo shots. Doc Brown used these for more persistant joints:

https://www.roadback.org/index.cfm?fuseaction=studies.display&display_id=184#Anchor-Injecting-17304

The purpose of using small amounts of cortisone in the injection is to reduce the amount of swelling, locally, just enough to allow penetrance of the antibiotic to the affected joint. Unfortunately, while cortisone shots can be pretty gratifying, affording relief from painful joints, there are downsides, including adding to the original joint erosion problem. Why? Well, my suspicion is that suppression allows the pathogens free reign to do their dastardly deeds. However, with the clindamycin being injected simultaneously, the positive effects may well outweigh the more negative ones.

My own herxing phase was pretty continuous in the first 3 months, until light started to finally break and blood markers started to decline. However, herxing has been off and on since then with pulsed dosing getting more tolerable, as the weeks go by, and less frequent.

All the best in your decision-making!

Peace, Maz

[Silvia]

Hello all:

thank you very much for all the very useful information regarding herxing and intraarticular injections.  Today my foot feels ever so slightly better, so I'm optimistic.  to the question as to why I stopped my meds, I'm still on Plaquenil, which I've been on for the last 6 or so years.  The enbrel and MTX did not work at all, and my rheumy told me to stop them.  He prescribed Humira, which I doubt would work, but it was at the time when I found this website, so I decided to go the AP route instead. 

I have a very difficult time with anti inflammatories, I've tried them all and they all make me retain a significant amount of fluid, so if anyone has this problem and has found one that doesn't cause this side effect for them, please let me know!

As far as the intra articular injections, I have destruction in several joints in my midfoot, so I think the injection would be a cortisone injection into the soft tissue that would give a generalized anti inflammatory effect to the whole area.  I will wait another few days and if necessary I will get this done.

thanks again to all for the great info and the good wishes.  Best to all!   Silvia

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