Methotrexate..what next? | Arthritis Information

My doctor wants to try adding something to my methotrexate. I can't start Enbrel because of latent TB right now. Her two ideas were either Arava or cyclosporine. She told me to look at the list of DMARDS read them over and let her know at our next visit what I thought.

So, any ideas? They all sound like they have potential bad side affects. Do I close my eyes and just point to one...eenie meenie minee moe? Jeeze, I'm tired of all this ...

What have you added to your mix that you found has the least side affects or has worked well for you?

I saw a post just now that Milly answered about being allergic to Arava...grreeat.

Thanks,

Hi Kelly...have you tried plaquenil or sulfasalazine yet? I've found that plaquenil added to the mtx really helped me. Not so sure about sulfasalazine..I don't think it's done much for me.

Good Luck!

Kelly

Kelly,

I am in the same boat - am LTBI [latent TB] and also take MTX.

I checked on the Arava and based on the warning, I'd probably try some of the other DMARDS mentioned above.

Tuberculosis Reactivation

Prior to initiating immunomodulatory therapies, including Arava, patients should be screened for latent tuberculosis infection with a tuberculin skin test. Arava has not been studied in patients with a positive tuberculosis screen, and the safety of Arava in individuals with latent tuberculosis infection is unknown. Patients testing positive in tuberculosis screening should be treated by standard medical practice prior to therapy with Arava.

Forgive me for not remembering, but is there some reason why you can't undergo the TB treatment? In my case, because of my age, it's contraindicated [unless I actually come down with TB and then all bets are off].

I feel for you. It always seems to be a matter of picking your poison.

I had severe abdominal pain on Arava that got worse and worse until I stopped taking it.

I'm currently on Imuran and I noticed a little queasiness (sp?) at first, but it subsided. The only thing that bothers me is the amount of hair I've been losing. I'm taking biotin to counteract it, but may have to up the dose on it after I talk to my doc in Feb. The hairloss was waaaay worse on Plaquenil.

Hi Sam & Kels,

Thank you for that information on Arava Sam. I will definatley steer clear of that drug for now. I have tried Plaquenil and it worked well for about a year, then had problems with extreme weakness and stopped it. Sulfasalazine , my mother is allergic to sulfas so my rheumy said we probably should not try this one. I'm worried because my RA is getting worse. Maybe they should just keep upping my MTX, I'm only on 12.5 mg and here thats not much.

"picking your poison " LOL ...sure right on that one!

I was supposed to start on Isoniazid for latent TB a few weeks back and scared myself into not starting yet... pharmacist said to avoid anything with tyramines in it because is could cause interactions with this drug. So, i did my research....too much research I must say because I even went to see a dietician for menu help. (that didnt help either, she had no idea) The list is huge... no cheese, no processed meats(peporoni, sausage, etc), no chocolate, ...I dug deeper and found you're supposed to stay away from histhamines as well...there goes tomatoes and a bunch of other things. So, I've stressed myself out so much, I havent started it yet. I will talk with my Rheumy tomorrow about this so called list that they never told me about. I read, it "could" cause problems, but not necesssarily...and me being a chicken over and meds I take , I said to myself I'd stay away from those foods for 9 months...pretty much bread and water...that's if there's no specific Yeast in the bread. Yeast is on the list too... ugh... too much research isnt good sometimes! LOL

Sam, do you take anything else besides MTX? any NSAIDS?

Mel: you had hair loss with Plaquenil? wow, i didnt even think that drug could do that. I'm sorry, that's not any fun!! I'll look into Imuran...How is it working for you besides the hairloss and queasy stomache?It was horrible! I called the doctor crying and she told me to immediately stop taking it.

I thought I was tolerating imuran well, but apparently my WBC was way too low. So instead of going from 3 pills to 4, I ended up back down on 1. I recently added doxy as well. Don't really notice a big difference so I doubt it's doing anything other than clearing up my skin. ;) I felt much better while I was taking the higher dose of imuran.

I take Plaquenil with Mtx. I remember a itchy type rash when I first started the plaq. It did not last long. I have been taking the 2 drugs together for the last year. I actually started the plaq then she added the Mtx. Worth a try. I hope you find the right cocktail and get good results.

Best Wishes,

Lisa

Kelly,

You mentioned your mom has a problem with sulfas…..I probably wouldn’t let that stop me. Just because she has a problem with them, doesn’t necessarily mean that you do, too. And even if you do, it might not be that bad. You can always start, then see where you are in a few days.

Incidentally, the common warning is that people with problems with sulfas should steer away from Celebrex because people with sulfa reactions tend to not do well with Celebrex. I’m one of those who swells up with sulfas – not much, but still noticeable. I keep telling the docs that I’m carrying around about 20# of edema. [They’re not buying it though.]

My medication regime:

17.5 mg MTX weekly

2 mg Folic acid daily

Aciphex [do I really need this?]

Benicar [hypertension]

Metformin 500 mg BID [pre-diabetes]

Celebrex 200 mg BID

Levoxyl .088mg [hypothyroid]

I’m in love with my Celebrex. I take max dose. I’ve tried other NSAIDS but they make me nauseous. I’m a wuss when it comes to that. I refuse the other pain meds because my brain becomes blotto.

Re the TB treatment – it’s hard on the liver. But consider that somewhere down the road you may exhaust a lot of RA meds and really need to try to newer biologics. If you keep waiting then you run the chance of your liver deteriorating with age, which would make TB treatment harder on you at some later date.

I don’t know if the doctors would be willing to do this, but you might ask your RD if he’ll start treating you for TB and give you a biologic [e.g., Enbrel] and if your liver starts pouting then you’ll revert back to other drugs. Granted, you’re going to have to give up some foods and antihistamines if you take the “treatment” but it’s only for about 9 months, give or take. Think of the benefits.

I’m not trying to persuade you one way or another, but there are a number of options. Sadly, none of them is going to be without sacrifice.

Keep me posted, Kelly.

PS One of these days I’ll add my drugs and diagnoses in my signature.