what should i do? | Arthritis Information

i have been on mtx for 7 weeks, i am suppose to be decreasing my prednisone,but every time i try i get horrible pain in my hip,warm to touch,cant sleep or hardly walk on it. i feel fatiuged,and fingers swell. i put a call into my doc.to see if i can stay at 15mg of prednisone for a while, and asked if she could increase my mtx, as i am on 10mg shot once a week. with little or no side effects. havent heard back yet. so i went back up on my own(pred) any thoughts?

kel

Sorry to hear your struggling. MTX eventually worked very well for me but it didn't do a thing until I was up to 20mg per week dose so your dosage sounds really low. After a couple of months I was able to reduce the MTX but only to 17.5 mg per week which I stayed on for about 2 years...now on Humira only.

Alan

My daughter brought me a 10 page report that one of the pharmacists
asked her to pass along to me. It was about the DMARDS and RA patients
developing resistance to these drugs. Sort of like antibiotic resistances
and cancer drug resistences that many patients develop. There are many
studies being done in this area right now. I read the whole thing and
could not understand half of what they were saying but here is the
conclusion that was written and this comes from: Medscape.

Given the long duration of drug treatment that most RA patients face,
maintaining the efficacy of DMARDS and biological agents for as long as
possible is a challenge. When effacacy is insufficient or lost,
rheumatologists switch to alternative regimens, the long lasting effects of
which might be unpredictable. Interdisciplinary research into drug
resistance has provided extensive knowledge of mechanisms associated
with resistance and toxic effects. some of the findings might apply to
DMARD treatment in RA.

Labratory studies have revealed various factors that can contribute to
diminished activity of specific DMARDS, some of which are currently
being evealuated in clinical practice. Of particular interest are studies
aiming to predict response to methotrexate when it is used as the main
drug in RA treatment. The most useful studies will assess response in
relation to specific resistance related parameters during the course of
therapy that mght recede clinical signs of loss of efficacy. This approach
will allow the extrapolation of date into predictive criteria. Thus,
pharmacogenetically guided, prospective clinical studies in early RA are
warranted.

The investigation of ways to make more efficient use of the currently
available DMARDS would also be useful, for example, modulation of
pharmacokinetics by blocking intestinal drug-efflux transporters and
ways in which second generation of drugs might overcome resistance
deserve further attention.

Finally, beyond the level of immune effector cells in peripheral blood,
more insight into factors of DMARD resistance related to inflamed
synovial tissue would be helpful to assist therapeutic interventions. any
extension of DMARD efficacy over time in monotherapy or in combination
with other DMARDs or biological agents will be beneficial from
therapeutic and socioeconomic perspectives.

So what I gathered from this is that we will all probably become
resistance to the drugs we are taking due to a complex number of
reasons. I guess it is time for them to get on the bandwagon and come
up with some better DMARDS or get this disease cured.

If anyone wants to look at this, you will find it at:
http://www.medscape.com/viewarticle/550574

Sorry to hear you're having such a hard time. First of all, consult your doc about your pain. The MTX takes a while to get going. If you're in pain when you decrease your pred, then I wouldn't decrease it. But let your doc know of this. And I tell you this being a hater of prednisone. I have suffered the long-term effects of prednisone. With that said, don't be in pain needlessly...it helps nothing or no one. Stress the fact that you are in pain and long-term use of prednisone will not be an option for you. Patience is a virtue with this disease sometimes and a lot of us have to endure incredible pain to get to where we should be. That's a sad fact. But by working closely with our docs, most of us usually get there. Let your doc know how you are, what your feeling, and the fact that you are going to have as normal a life as possible living with RA.

Sorry for the editorial.

Hi, I think you did the right thing, by increasing the pred while you wait to see your doc, you may or may not want to pass this on to him/her. You could sort of check by saying something like, 'if I have pain can I increase pred if I call you office, etc".????I hope the increase helped you as I hate it when people are suffering. (I tried less than 5mgs and had terrible pain, stiffness,swelling, etc.) So I know how you feel. I take 6 x2.5 mgs of mtx Friday....I can feel I 'need' it! soooo sorry, Sarah

MTX didn't help me that much either until I was on a higher dose. 10mg isn't that high and you've got a lot more room to increase verses continuing on that predisone. Obviously it's going to take a while for the MTX to work effectively; but one day you should expect your dose to be much higher and your predisone to be gone all together. THat should be your hope anyway.

Lorster as many long term RAers here will tell you that article is probable right on target. Over the years very effective treatments have been increased and increased and eventually changed entirelly because they were no longer effective. That's why it's recommended that you take the lowest effective dose because one day you will have to increase to get the same results. One day they will stop working all together and then you'l move on to another medication. It's rarely that anyone with RA that had it 15 or 20 years ago is still managing on the same treatment that gave them relief back then. I can only believe our bodies build a resistance to the medications over time.

thanks guys, i am waiting for my doc to call me back, i did increase the pred back to 15mg a day, today. and yes i feel much better. I have also increased my ultram, from 2 /day to 3-4 /day, it is losing its effectivesness as well.:( I have a hard time being paitent and waiting to feel better, i guess i will have to learn that.

kel