Do You Take Methotrexate for Rheumatoid Arthritis?
What about methotrexate and RA?
I answer that question frequently. People who are not taking methotrexate want to know how it feels and how it works. People who are already taking methotrexate for Rheumatoid Arthritis ask me how I deal with side effects. I’ve spent countless hours writing replies to questions about methotrexate and RA - everything from side effects to benefits to dangers…
From what I have read, about 90% of Rheumatoid Arthritis patients take methotrexate at some point. Methotrexate is the most prescribed disease modifying drug. And people tend to take methotrexate for a longer term than other drugs.
I have now published my answers to “frequently asked questions about methotrexate.” I hope that RA’ers find it helpful. There are currently 7 articles in these new Methotrexate & RA pages, including ”13 Things to Consider Before Flushing Methothrexate.”
As I wrote recently, you are the manager of your treatment. Although it is the physician who prescribes methotrexate for Rheumatoid Arthritis (or other autoimmune disease), you are the one who has to swallow the pills. My goal is to encourage you to learn as much you can and make the best decisions possible for you. And that is one reason why this website is dedicated to bringing inspiration and encouragement to fight Rheumatoid Arthritis.
Click here or use the Methotrexate and RA tab at the top menu:
Frequently asked questions about Methotrexate and Rheumatoid Arthritis
Is Methotrexate a Villain or Vanquisher? Methotrexate is the most commonly prescribed disease-fighting drug for Rheumatoid Arthritis. I am asked so many questions about methotrexate. Here, I have provided a basic overview of issues…
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I have been taking methotrexate for a little over a year, and I think I am doing really well on it. This surprises me because I don’t have a strong stomach. I take my big dose on Wednesday, but I find that Thursday is the day I need to plan for. I need to make sure I eat well so that nothing upsets my stomach. My much loved (and needed) coffee needs to be in the midday/afternoon not morning. No fruits, fried foods or acids – all steps to keep my stomach calm.
I try hard to schedule my life so that I can go to bed early on Thursdays. If I don’t do these things, then a lousy Thursday turns into a lousy Friday…
MTX was once in my medical regimine. The side effects for me were almost worse than RA and my doc switched me to biologics. Like many, I have mixed feelings about it. I know it provides relief for many (including a close friend with psoriatic arthritis). Some tolerate the side effects, others don’t. Like so many early RA medications, MTX’s effect on RA seems to be a mystery and it was not originally developed to treat RA. That’s why developing drugs specifically targeted at RA is so important. Thanks Kelly for writing this.
By the way, are you still taking Enbrel? I’ve been on it since March at which time it had a huge impact on me. But RA symptoms are returning and now I am now starting to think I’m back to looking at the next treatment.
Do you need to stop taking metho for a period of time prior to one’s weekly dose of metho and also for a period of time following the shot?
Mark, I am not sure what you are asking? Do you mean switching from oral to injectable? The doc can give you an exact schedule. I did not ever stop mtx except when I got an actual kidney infection. But many people are told to stop for any illness at all. What did the dr say?
I meant to say before getting a flu shot! Sorry about that!
The biggest side effect for me has been hair loss. Since it is a chemotherapy drug for kids, I still have my hair – -but I have HUGE bald spot on the top of my head.This RA is making me realize how vain I am. I had no idea!!
I was on MTX for 7 months until the mouth sores got so numerous and large (despite 2 mgs of Folic Acid daily and leucovorin weekly)it made talking and eating very painful. My last dose was 8-30 and my mouth has just healed. I am amazed at how quickly my pain and stiffness has come back. We are trying leflunomide now.
I have been on injectable MTX for over a year now. I would go to the top of the Statue of Libery, the Sears Tower, The Eiffel tower, the Space Needle- you name it- to sing the praises of MTX in my life. Since starting the drug I was able to tie shoelaces (twice even) for the first time in four years! Now- I can’t all the time, but the rest of me feels a heck of a lot better too. I take 1mg of folic acid daily and inject my MTX on Sunday morning (around 6am) to give myself a full day to relax and sleep- exhaustion and VERY vivid dreams during my naps on Sunday are my biggest side effects. We do injectable because I had an allergic reaction to Arava and Meloxicam and my Rheumy didn’t want to add anything more, especially at that dose, to my digestive system. Though I am on Enbrel, tramadol and cyclobenzaprine (I have Fibro too) MTX has made the biggest difference of any of the many therapies we have tried. I will fight tooth and nail before they ever get me off of this drug. LOL
I’ve been taking mtx for approx 2.5 years now & its been an absolute godsend.
Thankfully i’ve never been troubled much by nasty side effects though sometimes i feel a bit rough the day after taking it – its a small price to pay for having an almost normal life
I was diagnosed in July 2009 and put on MTX 25 mg weekly.Its not helping yet. Rheumy Dr has now put me on injectable, which is fantastic since I am a needle phobe
. Oh well, I will do just about anything to feel better. On my 6th course of high dose Prednisone to keep the inflammation at bay and it seems that that is no longer working. Waiting for eye doc to see if I can take Plaquenil too. Why do these medical professionals leave us in the dark?
I started giving myself the weekly methotrexate injections about a month ago…little did I know that the needle was going to play mind games with me….Aside from having to “get my nerve up”, the medicine itself has not been bad at all. I have noticed hair thinning (well more like pulling a small cat out of the drain after it starting clogging up!) but that may have already been happening due to thyroid issues. I stopped taking Plaquenil because of constant nausea and just feeling rotten. These injections have bypassed the stomach issues and I think that’s great. My most recent shot was given at bedtime and I think that was a good idea also as I need to lie down anyway right after the needle stick! I haven’t had any notable change in fatigue… no real improvement either, but I’m only a month into this regimen. My main complaint now is my feet… getting up after sitting for a while is not easy, but I know it could also be much, much worse. The rest of my body feels pretty good so I feel good about that!
Jenny,
Hope it gets easier. It will never be fun, but you wiil get more used to it, I think. Bedtime is a good idea too.
thank you Kelly, for what you do for us. I’ve taken metho for 14 years. I just learned a whole lot about it that wasn’t clear to me before reading your well written words
Methotrexate was the first RA med which my doctor put me on. When it began to take affect, I was thrilled to be out of pain. It continues to be fundamental to my treatment.
I had discussed the possibility of trying to get pregnant sometime in the future. In order to do that, I would have to stop taking MTX before hand. Just to see what my body would think about that, I stopped taking MTX for only a few weeks in the spring. The pain came back!! I started back on it immediately and thankfully it continues to work well.
Sometimes, I think we should call it a heartbreak drug. You can’t have a baby or even think of it. You can’t nurse your baby, if you have one already… For women of childbearing years ( the chief targets of RA), it is a heartbreaker.
Kelly…this is a FANTASTIC site…good work!!!
I started taking Kineret (an oldie goldie) in July after trying a host of other drugs…Mx, Embrel, Humira, Cyclosporine…I am much better in some areas. Not for the faint of heart tho…it requires a daily injection. EEK!
Can’t get off the pred which is causing huge problems with bone issues even though I also inject Forteo daily.
Thanks.
Kelly, et al …
I’ve been diagnosed with R.A. I was very very wary about MXT and the doctors at Mayo consented to letting me try minocycline instead, which seemed to work for a while. Then not. And thing are worsening.
I’ve been told that I now need to jump in the deep end and get on MXT. But I’m terrified.
I live overseas (Pakistan) where the medical profession can be laissez faire in the extreme (if that’s not mixed of a metaphor). I bought the MXT, but it’s from Korea United Pharma, and the Folic Acid is from Zara (Pak). I’m concerned too about prof’l level of the lab work.
I’m got bad asthma, and am concerned about the issue of immune suppression.
Has anyone had experience w/ taking this drug in the developing world?
I’m really on the horns of a dilemma, because if I shouldn’t be taking this here, I need to leave and which means unemployment.
Does anyone have any guidance re yr own experiences?
All the very best and thank you, Kelly.
Regards,
Dear jmccarthy,
Methotrexate has been a wonder drug for Rheumatoid arthritis & remains the anchor drug for RA despite all the advances we have made. If used properly, it is definitely a very safe drug. Methotrexate is started right at the onset & not at the fag/ deep end of the disease. Probably things would have been different if You had taken methotrexate at Mayo itself. Follow up regularly with your Rheumatologist. He would be the right person to monitor the effects of methotrexate.
Methotrexate does not worsen asthma. As a Rheumatologist from India, I can assure that immunosupression or the issues of tuberculosis are not very common with methotrexate.
So, go ahead, make the right decision, start with methotrexate. This is probably the turning point in your RA course you are looking for.
You may log onto http://arthritissupportboard.com/Methotrexate.aspx
http://arthritissupportboard.com/how_to_overcome_nausea_related_to_methotrexate.aspx for more information regarding methotrexate.
Dear Dr. Akerkar:
Are you aware of who’s who in world of rheumatology in Pakistan? I’m very concerned about the level of care here and the quality of the drug I’m having to procure.
I’m very wary about getting into this treatment here. I have an extremely high pressure job and if I can’t function or be able to rely on the medical profession with a high degree of confidence I truly wonder about the wisdom of getting treated here. If you have any guidance, I’d be very appreciative.
All very best,
Julie
Julie,
It seems that part of your concern the quality of the drug. Maybe you could talk to a pharmacist in the US about that. Do you have a relative here in USA who could help you get in touch with one. Methotrexate is a drug which has been around a long time, so it seems like it’s pretty straightforward. Otherwise, can you get the doctor to write that a specific brand is required and then you can know for sure. The only thing I can tell you for sure is that the brands can vary a little, so it’s best to try to stay with the same one each time.
For your labs, the liver profiles are also a pretty old and straightforward test. Maybe you could do them more frequently if you don’t trust the lab. Do you ever travel; can you schedule labs for when you travel to a better location?
Best of luck to you!
Take care of yourself,
Kelly
I dont know much about Rheumatology in pakistan.
U can try getting in touch with your mayo clinic Rheumie. He has seen your RA for quite some time & would know your RA charcteristics. Keep mailing him all your prescriptions. That, I’m sure would help you take decisions & add a lot on the confidence front as well.
For any queries/ guidance, feel free to get back to me.
You may also join me on twitter http://twitter.com/doctorakerkar
I would like to reiterate that starting methotrexate is not a bad idea at all & would probably the turning point you are looking for.
I have been taking methotrexate for six years.I take the drug on a wednesday,I take a drink of water followed by half a banana,then methotrexate,followed by half a banana,I then drink one litre of water over the next 30 minuts,I do this to flush the mtx through my kidneys.for me mtx as got me out of a wheelchair,my doctor told without this drug I would be back in a wheelchair.within weeks.dont give up on this drug it took 2 years to work for me by gradualy increasing the dose.
Good advice, Alan.
Hi Alan,
Was it really 2 years before the MTX started working for you?? i’ve been on it since mid dec and was told that at a full dose after 2 months i’ll be seein as good as it gets.. i;m still ettin a lot of pain daily so i hope there is still achance it’ll kick in more!
Hey Ed, just noticed this comment was not answered. How are you doing? From what I’ve read and docs have told me, 2 months is far too soon to know. I’ve read studies & known people who say they continued to improve for up to a year or more on mtx. Also, after a time, the dose may be changed. Even other meds work better with it, so even if it’s not enough, it’s usually continued. Hope this helps some.
I’m slowly working my way through some of the information on this blog. It has been recommended that I take Meth.. for the last year or so but I have been avoiding a decision. I’m still confused though. I’ve recently had a hole in my retina and as a result of that surgery a teeny cataract just grew by leaps and bounds and has now been removed. Fairly unsuccessfully since I still have blurry vision 4 weeks post op. Now I’m wondering if this is connected to RA somehow. I’ve managed thus far with just Ibuprofen, Diflunisal, Tylenol 3 when it gets really bad and occasionally 6 days of Prednisone. I think though the time has come for more serious medications since nothing really seems to work anymore. I’m pretty much at the end of my rope..ciao
Hi Rositta,
Hope your eye gets better. That sounds annoying. The meds you mention are for symptoms. If you have RA, it needs to be treated with a disease treatment first. One of the very first posts I wrote last year was about that. Click here to see. As for the methotrexate, did you see the Mtx pages up on the menu at the top?
Sorry to hear you are at the end of your rope. Hopefully if you can hang on it will get better.