methotrexate blues

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I have been taking methotrexate for 6 months and have barely felt any relief.
My doctor tells me to be patient. I also take indomethacin(sp?). I am at a
point where i can't tell if the indomethacin is this only thing remotely dulling
the pain. Previously i had been taking an older anti-inflammatory called
piroxicam. That and as much tylenol as i felt comfortable injesting. I
essentially feel the same. My question is how long?? Injectables are very
expensive and I find my self wanting to slam down a six pack out of
frustration. Of course i don't do this. I'm also paranoid about my liver
beacause i found out enzyme tests are not conclusive. IS methotrexate the
"gold standard" for treating psoriatic arthritis?? Does anyone use anything
to combat liver damage aside from folic acid? I forgot to add one important
point: I take 6 -2.5 mg tablets of methotrexate a week. I'm told this is a
small dose.

There's people that post in the RA listing that have PA. Some of the people here have more than one kind of arthritis. I don't have PA, at least not to date, so I can't help much with that.

I did however take MTX for about 18yrs. Several times I had to stop taking it for a short while because my liver enzymes were too elevated. As soon as my blood work came back ok I was back on the MTX again. The only thing people seem to take is the folic acid to protect the liver. A number of people who take Enbrel also take MTX. MTX stopped working for me so I take Imuran instead.

Welcome to our forum. See you around.

Barb

P.S. Check out the postings under ridges in nails

dyna38500.9013888889Thanks much for the reply. It's interesting that the methotrexate stopped
working for you. I don't think i've heard of imuran. I get the feeling my
doctor thinks i'm overly paranoid about the risk of liver damage. I have a
hard time with the vagueness of the stuff. I suppose they protect themselves
by introducing a warning regarding possible "side affects". The next stage
for me ... more pills probably. If i only had the psoriasis i would at least have
homeopathic remedies and acupuncture and not be enslaved to drug
companies. Oh well.
best regards

Let me add my experience

I started taking MTX by injection in 1995-I had pleuritis which is inflammation of the lining of the lung, caused by the PA. That hurts like you know what. I mention that because I am a med rebel and resist most chemical intervention, but hey, you do what you have to do.

It did work. It put me in remission. I took it for five years but I hated, I mean HATED the side effects: nausea, constant tiredness, stupidhead syndrome. I stopped it in 2000-and remain in remission. Actually I'm kind of borderline remission right now. But there is hope, THERE IS ALWAYS HOPE. The weird thing about arthritis is you never know when it's just going to go away.

I have the kind of PA that gets you all over: knees, ankles, toes, shoulders, wrists, knuckles, hip...you name it. One gets to form an intimate relationship with pain when they have this disease. It's just kind of around all the time.

Back to the MTX: Folic Acid is the bomb when you are on the regiment. Don't ever not take it. And as far the liver, I would advise not to dwell on that. If you are on the MTX you probably don't have a choice. Just keep up w/ your folic acid and do not engage in any other activities that can harm your liver, most importantly I think: DO NOT DRINK ALCOHOL. Not even a little bit. It's just not worth the chance. On a hopeful not, after my five years I suffered NO Liver damage. Just be aware. Lastly I will say, although I really HATE MTX , it does the job. I think back to 30 years ago when the only recourse were even more evil drugs that really didn't stop the progression of the disease (ie gold, prednisone) A friend of mine's mother had this disease, diagnosed in the 70's and was very crippled. Because of MTX and other advancements in treatment we are blessed with the opportunity to avoid that fate.

Keep up the good fight,

Hi,

I'm new to this board but do participate in one called LupusOz (Australia). I found you guys by searching for info on PA...something my Lupus has thrown up as another challenge for me for the past 18 or so months. Am interested to hear people's experiences with mtx. My Rheumy says that's an option if the symptoms become overwhelming. I don't want to go on it so am toughing it out on Plaquenil and NSAIDS. Thankfully the Plaq has the symptoms under control but my ankles/feet are killing me by the end of the day. I've been on Imuran for other Lupus things and did go into remission then for about 6 years actually. I'd love to think the mtx could bring about remission...I am an optimist

The few posts that I've read haven't mentioned Plaquenil. I'm presuming that this drug is prescribed in the U.S. too.

Anyway, I look forward to chatting in the future and I'll read your posts with interest.

Lynne38668.804224537I've had psoriasis for years on my skin...then it mostly disappeared, but reappeared under certain finger and toe nails - agghhh, within the past year I started getting pain in my joints, where the psoriasis was under my nails. The pain came on pretty fast and was progressing rapidly, so I went to a RA physician; he put me on MTX, only 7.5 mg/weekly; at my 2 month visit I reported it wasn't helping and was actually getting worse, so he prescribed humira as well; although my insurance didn't cover it, I was accepted into a program to receive it for free (may be a state thing, I live in West Virginia). After the first injection I didn't notice anything until my weekly mtx intake, the next morning I woke up with less pain : ) I take approx. 1 mg folic acid weekly - still consume a bit of alcohol - and my liver tests have been okay so far...I am on enbrel and arava and it works wonders for my pa. NOw you need to know though it does take time for your body to adjust and it will feel better. It took about a year for me. I was first on mtx, then with the enbrel, but we found out as the dosage of mtx was raised, I got more body rashes form the mtx, so I was switched to arava. I swear by the dosage, but everyone is different, just remember it is not going to cure the psoriasis, you can still get flare ups just like with the pa. I use to work nights which was very hard on my body, but now I work days get proper sleep, and try to keep to a good diet. I am right now dealing with a flare of inverse psoriasis, but I feel my quality of life is so much better, even my rd has noticed a change in my attitude and the way I walk etc. I do deal with ra, oa, and hypothyroidism, but I have been doing so well lately that if you met me you wouldn't beleive I had these problems or that I was the same person if you had met me 2 yrs ago, this is how much better things have been. ask your dr about enbrel or humira shots the enbrel are 2 week while humira is 1 a week. I hope this helps if any questions please feel free to pm me. It may take a couple days for me to answer you but I would be glad to answer any questions. meme

meme38683.7457986111

i was on MTX for about 3 years. I didn't notice much of a difference from it, except for the side effects, which is why i went off it. I couldn't stand being tired all the time, and feeling sick, having my hair fall out, and all this with no pain relief. I was on the maximum possible oral dosage. I talked to my rhuemy and she said that she would consider putting my on Enbrel instead if my TB tests came back okay and if my insurance covered it, since it is really expensive. Anyway everything was fine with the tests and insur. so i have been taking that now for about 1 year. It is the best thing that has ever happened to me. I am a new person now.

Someone was talking about plaquenil, i was on that for a while too, but didn't notice anything, i was actually on that for a really long time, i think its when she put me on MTX that she took me off plaquenil.

I have Crohn's disease and enteropathic arthritis and I take 12.5mg intramuscular injection once a week and have found that it is much more effective than taking it orally. I also need a smaller mg dose injected than I previously took orally to be effective, so that helps with the liver as well as side effects. My liver enzymes went high whenI drank alcohol or took Tylenol, so I cut those two things out and so far so good. Hope this helps

!There's not a drug that works for everyone. My husband has taken Methotrexate for a year and a half, and he's only gotten worse. The rheumy wants him on Humira, but our insurance doesn't cover it and we make too much money for financial assistance. Young wife, Will your insurance cover Enbrel? Usually with letters of necessity from the physician, that outline the progression of the disease and the necessity of using the drug the insurance company will cover, maybe not at 100% or even 80% but they'll cover it. Have you tried all the levels of appeals that your insurance requires? Sometimes it takes getting the primary care doctor involved also.

Remicade is an infusion drug that one can be infused as an outpatient at the hospital and many insurances will cover Remicade and the infusion because it's considered an outpatient procedure. They wouldn't cover the drug or infusion when it was infused in a doctor's office. Go figure!!!

Your husbands RD could add another one or two dmards in addition to the MTX. There's Plaquenil, Arava, and Sulfasalazine. Not sure if Plaq and Arava are used for PsA but I know that Sulfasalazine is. I'm taking it along with MXT.

It's true that MXT alone doesn't work for some people and there needs to be additional DMARDS added or a biologic. For many people MXT works well. I hope that a solution can be found. You've probably tried many of the things that I just wrote about but just in case I wanted to give you the information. PM me if you have any questions. I worked in the health insurance industry for many years. Lindy

You can try calling the pharm co directly and seeing if they can help any. I was on humira for a number of years before it stopped working for me. I am now on Remicade and it is more expensive and also does require a trip to an infusion clinic. I really preferred the convenience of being able to inject at home instead of having to schedule appts. There are other meds out there to try. Ask the rheumy. Hope things are better soon.