RA (with pulmonary fibrosis too) treatment options?

Diseases & Conditions Rheumatoid Arthritis
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Hi!  I am new here & I'm posting a question for my mom, who has rheumatoid arthritis.  She has had it for many years (20+) now & she has also been diagnosed with pulmonary fibrosis, which has complicated her treatment.  Because of the PF, she cannot take some of the newer RA drugs, as they are potentially too damaging to the lungs/too likely to make her get an upper respiratory infection.  The docs say there is no way she can take drugs like Humira, Enbrel, Remicade, Orencia, etc. because of this.  She is already taking Plaquenil, Imuran, Arava, Celebrex, & Prednisone.  Unfortunately, the RA is progressing.  If any of you have any treatment suggestions, I would greatly appreciate it!  (Or if you know of any good websites, articles, etc.) 
 
My mom has fought this disease for so long, I hate to see her struggling so much at this point.
 
Thanks for your help!
 
bears_fan
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Hey bears_fan! Welcome to Healing Well. You will find a huge wealth of knowledge here. Let me do some research and I will get back with you. I'm sure also that a few of our nurses that post here will be along shortly to give their 2cents. How sweet of you to do this for your mom! Take care and keep posting! Duck

Diagnosed January 2005 - Psoriatic Arthritis/Spondylitis
-Currently taking 50mg shot weekly of Enbrel
Diagnosed May 1998 - Graves Disease
-Complete Thyroidectomy September 1998 - While 11 weeks pregnant
Other Complications - GERD/Scoliosis/Hiatal Hernia/Graves Disease of the Eyes
Current Meds -  Enbrel/Prevacid/Synthroid
Past Meds - Inderal/PTU/Prednisone/Voltaren/Feldene/Mobic/Cortisone and Steroid Shots

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Hi bears.
What state do you live? I'm suspecting Il. but that's just a hunch.
Is she under the care of a rheummy that is affiliated with a major university hospital?
This is a very bad situation as the TNFs and Dmards all help slow the progression, yet it is contraindicated in her case due to the lung fibrosis.

Wow, what is more important at this time? It's a tough complicated call.
Yes, she shouldn't risk getting pneumonia or TB or any Resp infection in that matter. What is her age? I ask because that could be the main factor of weighing the options.
If your mom is say around 70 or over, starting the TNF meds might be too risky for the lungs & pain management for RA might be smarter, keep the prednisone and Imuran and all.
What are the dosages of Imuran she takes?
Is a rheummy & pulmonologist working together on this?
This is hard....RA progresses and can cause worse heart & lung problems....and God, so can the treatments.

Is she on the highest possible dosages of the meds she is on?
Prayers are with you. Write back soon.
Erin

Active, Severe RA. Crohns Disease. Chiari Malformation & Right Brain venous anomoly. AS. Emphysema. Rheumatic Lung. MVP and Tricuspid prolapse. Had Lymes disease for 10 years.
Meds: Humira 40mg every 4 days; pred; Pentasa; Imuran; dilaudid; diazepam; Avinza 30mg; MiraLax & too many others.

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Erin-

Sorry, I haven't been around in awhile.  I was in the hospital with a blood clot. 

Thanks for replying to my question!  Now let's see if I can answer your questions.

Yep, I'm in IL...hence the bears fan.  Are you close by?

Yep, my Mom's rheumatologist is at a major teaching hospital. 

Her rheumatologist & pulmonologist do communicate to some extent, but I know she wishes there was more communication between the 2 of them.  The times they tend to talk most with each other is when my mom is hospitalized. 

My Mom is 62.

She takes 200 mg of Imuran.

She is not on the highest possible dosages of all the medications.  For example, she currently takes a very low dose of Prednisone because she just had cataract surgery done on both eyes within the past 6 weeks.  (These meds. have some lovely side effects!)

Thanks for the help.

Hope you are doing well!