Methotrexate--how long to wait? | Arthritis Information

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Hi all.  I'm new here and have a question (I searched here but couldn't find an answer): I have been taking Methrotrexate (7.5 mg) for about two months now.  I am experiencing very little benefit so far and was wondering how long it should take to really help.  Can some of you tell me what your experiences have been with this drug?

 
Thanks.
Dear Joan,

I think this varies from person to person, so don't take just my answer for the only possibility.

Having said that, I started with 15mg MTX per week orally along with 10mg prednisone and 200mg Celebrex per day.  At the beginning of MTX I felt really dopey, tired all the time.  I took the tablet on Friday and could just about write off the weekend.  I was lucky I was awake enough to go to work on the Monday (I'm an adult education teacher and need my wits about me!).  I felt no better nor worse, muscle-wise but was told to stick it out for ten weeks until the benefits could be seen.

I was told to have blood tests, at first after 2 weeks (no adverse comments) then after 8 weeks, whereupon my GP was alarmed and told me to stop taking MTX because of liver problems.  It was this which made me tired.  So, back to the rheumy, low fat diet, no alcohol, no more MTX and (unfortunately) back to 10mg prednisone, which I had got down to 7.5mg in the meantime.  Didn't feel good, though.

I'm next due for a rheumy appointment in November and am waiting to see if he recommends taking the "poison pills" again . . . I'm not enthusiastic.

A friend of mine takes injected MTX for rheumatoid arthritis and has no problems with it - I didn't even know she had RA until I confided my PMR problems. . .

Hope you see some positive effects.

Best regards,
C.


CandleintheWind,

I hope you are doing better now.
My rheumy wants me to try mtx. I don't want to.  She says that mtx will help my immune system. 
Does anyone understand how mtx can "help" the immune system?

thanks,
freesia
freesia2010-07-18 18:19:22 Hi Freesia,

I've never taken Mtx myself, but I've read that mtx suppresses the immune system or makes it less active. Maybe that's what your Dr actually means by 'helping'?  Here's a link that might help explain:

What is methotrexate?
http://familydoctor.org/online/famdocen/home/articles/628.html
RickF2010-07-19 13:12:08Hi all!
Methotrexate is a member of a group of drugs called DMARDs (disease modifying anti rheumatic drugs) and these drugs actually change (modify) the effect of the disease on the joints so are used in diseases like rheumatoid arthritis where the joints actually become damaged beyond repair if untreated. I have been unable to find any publications which present evidence it works in PMR - there are some anecdotal reports but not particularly encouraging. I may well have missed something though so don't take that as gospel. I will go away and look again but am at a scientific meeting on Lake Maggiore in northern Italy at present! Hard life but someone's got to do it!
 
will report back later!
MrsE
Joan, just curious to know if you are also taking prednisone along with the mtx?  My rheumy has me on prednisone (tapering at this time) along with mtx 7.5 once per week.  I also take folic acid 1mg daily because mtx can deplete the body of this supplement.  Heck, I don't know, I'm new to this whole PMR thing too but trying to learn as much as possible.
 
I've been on this regiment for about 2 months now and was feeling pretty good until recently but am going to start another post about my problems so check for my new post.  Not sure if the mtx is helping or the just the steroids are making the PMR symptoms better to handle.  My rheumy says that taking the mtx helps with the steroid taper.  But when you read my new post the taper isn't going that well.
 
Only good thing is I don't see any real problems with mtx side effects.  I take it on Sat. mornings and haven't had any nausea or fatigue problems from it but I don't tend to have many problems with med side effects.  Some people are just more prone to med tolerences.
 
I also have osteoarthritis in my spine but haven't seen much improvement with that since starting the steroids or mtx.
Hi all! The promised update on MTX in PMR:
 
The only study I can find references for was carried out in 5 centres in Italy in about 2002-2004. Just over 70 patients were split into two groups, one group was given just steroids and the other got MTX as well for the first year. They were followed for 18 months. At the end of the study it was concluded that the patients who took MTX had fewer flares in this period.
However, it has also been pointed out by peer reviewers that over the whole time the patients did not take significantly less steroid medication and that the period when there were fewer flares for the MTX group was in the 6 months AFTER stopping taking it. It is not believed that there is any longterm effect due to MTX so it is not clear why this effect was seen. Since this was a single small study and there were some flaws in the design, this seems quite vague evidence for using MTX in PMR. The idea is that it helps during the tapering of the steroid dose but it is really not conclusive as far as I can see in the literature.
Personally, I might be suspicious that  the drug reps from the company making methotrexate are using the slender evidence in a single peer-reviewed study to establish a new area of use for this drug. It has been used in rheumatoid arthritis and does have a role there but there really does not seem to be any evidence for benefits in PMR. It is a nasty drug and you need to be monitored very closely for liver effects etc. - so if your doctor isn't doing that they should be. So, if your doc has had good experiences than I guess it's fair to try it - but have they? I would like to hear their arguments for using it. And from anyone else who has found it helpful.
 
cheers all,
MrsE
 
Hi RickF,
Thanks for your link--that was interesting. Hmmmm...I wonder why suppressing the immune system would help pmr? I don't particularly like the idea of suppressing it!

MrsE, thanks for your update on mtx use for pmr.    I haven't asked my rheumy what her experience has been with patients who took mtx.

I just found out that an old family friend has been taking it for 25 years for RA, and not had any bad side effects.

freesia
freesia2010-07-31 15:44:46
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