Effect of Remicade, pred., MTX, plaquenil, celebrex on fracture healingEffect of Remicade, pred., MTX, plaquenil, celebrex on fracture healing

Complete fracture of ulna 4 weeks ago. Also hairline fracture of elbow. In a long arm cast for 2 wks at which time x-rays showed healing. Put in fracture brace - within 3 days agonizing pain, feeling of bones moving. X-ray showed nonunion - in other words arm rebroke. Back in long arm cast for 2 weeks hoping to avoid recommended surgery. Will REFUSE to wear fracture brace again, doctor said short arm cast a better option.

So after 4 weeks I am back to where I started. How much do my meds have to do with healing? How long can I expect this to take?

Thanks.

Answers from our Doctors

josephbiundo's picture
Dr. Joe Biundo says:

This is a very difficult question to answer. Too, additional information about age, gender, and whether a diagnosis of osteoporosis is present would be important to the discussion. If osteoporosis is present, what is the T score, and what is the treatment, what is the vitamin D level?
I will try to give a general answer based on the available information. Plaquenil, methotrexate and Remicade should not have any ill-effect on the healing of a fracture. It is possible that prednisone has contributed to the presence of osteoprosis, which could delay fracture healing. That issue could be determined by obtaining a bone density test. The vitamin D level could be determined by a blood test. Low levels could contribute to slower healing. I am very doubtful that Celebrex would play any significant role in this case. There have been some reports that bone fusion in spinal surgery may be delayed by concomitant administration of non-steroidal anti-inflammatory drugs, such as Celebrex, and ibuprofen, but this has not been proved and I have doubt that this is the case.
So, in terms of your medication,that leaves us with some possible influence from prednisone. Some people feel that cigarette smoking can even delay healing. All that being said, nonunion of an ulna is not rare, even with no risk factors. Some angulations of a fracture are more difficult to heal than others. The short arm cast seems like a reasonable choice for you now. You could still end up needing surgery to heal the fracture. I hope all goes well.

Monday, April 19, 2010 - 20:53

Comments

Guest
08/12/2010 - 07:21

I have an aggressive form of errosive osteoarthritis, osteopenia, Sjogren's, Raynaud's, IBS and many allergies and chemical sensitivities. After a year and two surgeries to place bone grafts in the PIP joints of three fingers, two have begun to fuse. My doctor said the other one is unlikely to fuse. He added, "...but I've been wrong before." He does not recommend a third surgery. My fingers are very small. He said there is too much chance the finger would die. We started bone stim therapy over a month ago. Two fingers show definite healing. We'er hoping the 3rd responds also.

During that year, my vitamin D and iron level have been low a few times. Sodium is always low. An "Arthritis Today" article indicated that Prevacid blocks uptake of all forms of calcium except calcium citrate. Adding it and vitamin D3 to my supplements brought my T-score out of the osteoporosis range. Adding strontium citrate brought further improvement. So the non-unions have been very frustrating.

While looking for information on factors that accelerate osteoblast formation and slow their destruction, I found that vitamin K2 promotes bone formation, but does not affect coagulation factors. Adding K2 seems to have help speed fusion of my PIP joints. It definitely has increased my enegry levels. Fatigue still hits me if the iron or D levels drop.

I do a fair amount of gardening, so I should get enough sunlight. Are other factors that would inhibit vit. D formation?

Thanks for your input.

Sincerely,
Bonnie Ramsey

Guest
09/22/2010 - 08:31

Do you advise taking folic acid supplements during treatment with MTX. I have read conflicting advice. My concern regarding folate is that long-term MTX therapy can be hepatotoxic due to low levels of folate and of course it can contrubite to anemia.

Guest
04/14/2012 - 13:41

I recently had a JONES fracture on my 5th metiorsal. The Orthopedic Dr recommended that I take a daily dose L-arginine, An Anamio acid also called AKG. I took the recommended dosage (1 750mg daily) for 6 weeks. X-Ray at that point, one could not see the fracture at all.
Ortho Dr said Mayo Clinic is using/trying this for the inner bone healing. For me it really worked. (I did wear a boot)
I am currently on 700 mgs Remicade every 6 weeks, 20 mgs of Methroxate every week, Daily: 1 mg folic acid, 1 7.5 mgs Meloxican, 60 mgs Cymbalta, 2.0 mgs prilosec, Multivitamin, 1200 mgs Calicum, 2000 mgs Vitamin D.
I am 70 years of age, I am on the plus side of done density. I had no problems with my meds and had god healing!

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