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#271607 - 06/08/15 02:04 PM is MTX really just for peripheral symptoms
elenef Offline
Registered Visitor

Registered: 03/25/15
Posts: 99
Loc: Illinois
i have seen several people on past topics/posts say this and i am wondering if that is a fact, or maybe just opinion based on how they feel their body responded to it. (which as we all know could vary quite a bit, so how to know if MTX was the reason)

because if MTX is a DMARD, how would it know to 'only' target peripheral areas instead of the spine? wouldn't it just target all joints?

just wondering if anyone else knows this. my Rheumy has me on both MTX and Humira, but did not say that one was for peripheral and the other axial...
_________________________
------
Female / 43 yrs old
~ Pain started in 2000
~ dx w/Cervical Myofascial Pain Syndrome in 2003
~ dx change to USpA/AS in Feb 2015 (HLA-B27 negative)
Currently taking Gabapentin 300mg/nightly, Meloxicam 15mg/daily, MTX 7.5mg/weekly, Folic Acid 3mg/daily, Biotin 5000mg/daily, and Flexiril & Norco only when absolutely needed.
tried Humira--no success, Enbrel & Cimzia--severe allergic reactions.
started Simponi infusions Jan 2016.


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#271608 - 06/08/15 03:48 PM Re: is MTX really just for peripheral symptoms [Re: elenef]
Banana Offline
Registered Visitor

Registered: 07/23/06
Posts: 6450
Loc: New York
OK, I have always needed additional medications, additional DMARDs because Humira, Enbrel etc etc is not enough. It isn't that a medication helps one part or another, but one medication isn't enough to help every part. My neck, spine are the first to feel better when I start a new medication and as I take it awhile or add additional meds--I can feel as best as can be my hands, ankles etc--not counting permanent damage.

Think of it as extra protection because if only I had started MTX when it was suggested, I would have less damage. I kept saying no, because of misinformation.

Once you fail one or more anti TNF, many doctors add another medication. It not only boosts how it works, but prevents it from stopping working. Example first time I was on Humira, it worked like a miracle for three months and then stopped working--turned to water. When I took it again with MTX, it worked for almost a year and that was the third time I took it. If I would have taken it right away, I might still be on it--instead of at least 10 med fails.

MTX doesn't help/prevent fusing---BUT for many people, esp women, there is much more to the disease then just fusing.

Ana
_________________________
Actema IV once a month (with pre loading for allergic reaction), Cymbalta x1 daily, Arava 20mg daily. Diagnosed with AS in 2004, suffered undiagnosed since 1982.

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#271610 - 06/08/15 05:55 PM Re: is MTX really just for peripheral symptoms [Re: elenef]
CanuckMom Offline
Registered Visitor

Registered: 11/30/10
Posts: 195
Loc: Niagara Falls, Canada
It's now pretty standard practice to add MTX with biologics to increase benefits and limit side effects like antibody development. There is a lot of the web about this. It's also pretty well documented that DMARDS have very little effect on the axial symptoms and pain but do help with peripheral symptoms.
_________________________
Officially dx'ed Nov/10 after being symptomatic 10+ yrs. HLA-B27 positive. 200mg Celebrex twice a day, Targin for pain. Started SSZ in Nov'13 for peripheral issues. Jan '14 added Gabopentin for SI flare related nerve pain. Nov '14 added MTX to the mix. July '15 liver enzymes went crazy and off SSZ and MTX. Back on both at reduced dosages in Aug'15. March '16-son#1 dx'ed AS


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#271614 - 06/08/15 06:46 PM Re: is MTX really just for peripheral symptoms [Re: elenef]
SouthernMoss Online
Registered Visitor

Registered: 03/12/13
Posts: 1654
Loc: MS
It's a fact that mtx generally does not help spinal symptoms. It's been documented in several studies. I don't have links to any studies, but you can hear it from the mouth of an AS specialist if you go to the 43:26 mark on the following video of Dr David Hallegua, a nationally recognized expert on SpA.
https://www.youtube.com/watch?v=JZIqaiq3PG0

I don't think the DMARD "knows" anything or says "you know what? I don't think I want to fool with the spinal problems." smile It's probably more a function of the differences of the spine vs other joints in the body.

Studies have shown that mtx helps biologics like humira and enbrel to be effective longer, which is why they are often prescribed together.
_________________________
Ginny - 56 year old female
Dx with USpA in March 2013; changed to AS in July 2015
Iritis and Scleritis
unicompartmental knee replacement June 2014
MTX, Humira, Cyclobenzaprine, plus Indomethacin ER as needed
Supplements: Folic Acid, Vitamin D, Calcium, Fish Oil, Melatonin, Culturelle probiotic

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#271620 - 06/09/15 12:09 PM Re: is MTX really just for peripheral symptoms [Re: elenef]
Mary Beth Offline
Registered Visitor

Registered: 04/14/05
Posts: 2091
The spinal joints are not at all the same as peripheral joints. The makeup of the joint is very different.

There are decades of studies that show that DMARDs don't work for axial arthritis. This is not really in dispute.

There is mixed research on whether or not MTX helps the other biologics. Generally speaking, from what I have personally read, there is good evidence that it helps keep antibodies from forming for Remicade. unclear evidence for Humira, and not much evidence for Enbrel.

However, the jury is very much out as to whether antibodies are what keep the drugs from working or not.

Enbrel worked for me for just a few years before it stopped, yet there is little evidence that people form antibodies to Enbrel.

http://arthritis.about.com/od/enbrel/f/enbreleffect.htm

I trust my rheumy. My rheumy does not routinely prescribe MTX with Humira or Enbrel. I have been on Humira for many years with no drop-off in effectiveness.

Combining DMARD with anti-TNF may increase the risk of immune-related side effects.

Talk to your doctor, would be my suggestion.


Edited by Mary Beth (06/09/15 12:10 PM)
_________________________
46, diagnosed with AS in early 2005 and on TNF-blockers since then: They have been miracle drugs for me. On Enbrel from spring 2005 to Nov 2008. On Humira from Nov 2008 to present. Baclofen and OTC anti-inflammatories as needed.

"You must be the change you wish to see in the world." --Gandhi

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#271622 - 06/09/15 04:10 PM Re: is MTX really just for peripheral symptoms [Re: elenef]
drizzit Offline
Registered Visitor

Registered: 02/18/06
Posts: 1930
I agree with Mary Beth. MTX can be a great choice if you need the extra help with peripheral symptoms if the TNF is not completely doing the job. On Remicade I think the MTX is an option as well.

My Rhemy also does not prescribe MTX along with the TNF (except for remicade) unless the extra help is needed on peripheral symptoms.

He also says sometimes antibodies form and the TNF drugs keep working. The makers of SImponi do not recommend the automatic use of MTX along with Simponi for AS. I have been on simponi alone for 4 years and no drop in effectiveness. I want to be on as few meds as possible and still get full relief. I mean take what you need but no more.

If you trust your doc then follow their directions. If you don't then switch docs.


Edited by drizzit (06/09/15 04:13 PM)

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#271639 - 06/11/15 12:31 PM Re: is MTX really just for peripheral symptoms [Re: elenef]
elenef Offline
Registered Visitor

Registered: 03/25/15
Posts: 99
Loc: Illinois
thanks guys, that all does make sense. i just wasn't sure.

whether MTX helps with the other biologics (like Humira) i guess doesn't matter too much in my case. i have a good amount of peripheral symptoms in addition to my axial symptoms, so if they could each do their job well, i will be a happy camper!

fingers crossed. smile
_________________________
------
Female / 43 yrs old
~ Pain started in 2000
~ dx w/Cervical Myofascial Pain Syndrome in 2003
~ dx change to USpA/AS in Feb 2015 (HLA-B27 negative)
Currently taking Gabapentin 300mg/nightly, Meloxicam 15mg/daily, MTX 7.5mg/weekly, Folic Acid 3mg/daily, Biotin 5000mg/daily, and Flexiril & Norco only when absolutely needed.
tried Humira--no success, Enbrel & Cimzia--severe allergic reactions.
started Simponi infusions Jan 2016.


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#271646 - 06/13/15 07:30 PM Re: is MTX really just for peripheral symptoms [Re: elenef]
TBSchemer Offline
Registered Visitor

Registered: 08/01/14
Posts: 90
Loc: WI, USA
MTX has been shown in several studies to reduce the elimination of Humira from the body, increasing its effective concentrations and effectiveness.

So, I don't think there's much evidence that MTX helps axial symptoms on its own, but it can increase the effectiveness of Humira, if you only got a partial response to that biologic.
_________________________
26 year old male
Dx 08/2014: Non-radiographic axial spondyloarthritis (nr-axSpA).
HLA-B27+, uveitis.
Meds: Remicade (300mg/6wk), dexamethasone (?mg/6wk), MTX (15mg/wk), folic acid, fexofenadine, montelukast.

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#277754 - 04/15/17 03:57 AM Re: is MTX really just for peripheral symptoms [Re: elenef]
AllieG Offline
Registered Visitor

Registered: 04/10/17
Posts: 3
Loc: Austin, TX
I use MTX once a week, along with remicade every six and oxycodone daily, plus five days a months on Prednisone. I still have pain. I'm sure MTX is great, it really has taken alot of my.pain away, but would not work on me by itself.
_________________________
Allie G., female
Ankylosing Spondolytis Sufferer since 2013, symptoms since 2011
Austin,TX
Remicade(500 mg/every 6 wk)
Methotrexate(25 mg/wk)
Oxycodone(10 mg/3x a day)
Prednisone(10 mg/ daily for 5 days)
Folic Acid(10 mg/day)
Vitamin D(1,000 IU/day, 50,000/week)
Tizanidine(4 mg/3x a day)
Gabapentin (1200 mg/3 x a day)

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#277790 - 04/19/17 12:55 PM Re: is MTX really just for peripheral symptoms [Re: elenef]
Sean O Offline
Registered Visitor

Registered: 09/27/07
Posts: 254
Loc: Toronto
The American Rheumatology Association has said that methotrexate has no role in the treatment of ankylosing spondylitis.
_________________________
Male, early 50s, Dx AS+ 1991, HLA B27+, Tylenol 3 PRN for flares. Off NSAIDs due to stomach issues. Considering a biologic. SI and thoracic involvement and costochondritis. Many bouts of uveitis. Small bowel issues, anemia.

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#277797 - 04/19/17 10:07 PM Re: is MTX really just for peripheral symptoms [Re: elenef]
Ucla08 Offline
Registered Visitor

Registered: 03/13/17
Posts: 10
Okay, I'm no expert but I am a researcher by training and I've been trying to educate myself on the AS research and just wanted to jump in about MTX having no role in the tx of AS since I've seen this elsewhere.

In their 2015 paper ( American College of Rheumatology ) they say "In adults with active AS despite treatment with NSAIDs, we conditionally recommend against treatment with SAARDs..." and then they cite the lack of evidence for its effectiveness (i.e., we don't have enough good research to say that it works) but also the lack of quality research (i.e., we don't have enough good research to assess whether it works).

On the AS fact page on their website ( Spondyloarthritis - American College of Rheumatology ), they say "For patients who do not respond to the above lines of treatment, disease modifying antirheumatic drugs (commonly called DMARDs) such as sulfasalazine (Azulfidine) might be effective."

There are two relatively recent Cochrane reviews on AS and MTX (Methotrexate for ankylosing spondylitis. ) and SSZ ( Sulfasalazine for ankylosing spondylitis. ). Regarding MTX they say, "There is not enough evidence to support any benefit of MTX in the treatment of AS. High-quality RCTs of larger sample sizes are needed to clarify the effect(s) of MTX on AS." For SSZ, their conclusion is more equivocal but similar, "There is not enough evidence to support any benefit of sulfasalazine... in the treatment of AS. Further studies, with larger sample sizes, longer duration, and using validated outcome measures are needed to verify the uncertainty of sulfasalazine in AS."

I'm not disagreeing with the earlier comment but I just had to point out that there's a big difference btwn "there's good evidence to show it does not work," and "there's no good evidence to show if it does or does not work."



There's a recognition of the role of DMARDs with AS but that it's different than with RA: "The term 'DMARD' has been borrowed from rheumatoid arthritis, and none of the DMARDs have been shown to prevent or significantly decrease the rate of progression of structural damage which is required to be qualified as a disease-controlling antirheumatic drug for AS." (from Best Pract Res Clin Rheumatol. )

Others have noted the evidence that DMARDs reduce the frequency with which biologics are rejected by the body ( Ann Rheum Dis. 2013 ). So even if a DMARD might not be disease modifying for AS, "An important question is whether MTX should be prescribed in combination with biologic therapy in patients with AS, where DMARDs are not routinely prescribed for axial disease... Concomitant use of MTX may improve drug survival, reduce immunogenicity and prevent secondary inefficacy, which is of particular significance in AS and psoriasis, where, compared with RA, there are fewer classes of biologics to switch to in the event of treatment failure." ( Rheumatology (Oxford) (2014) )

So, it's complicated. I don't know if any of that helps with the original question and I've probably just made myself look like a crazy person by nerding out on all that research so I'm going to go back into lurking mode...

**slowly backs away from computer**


Edited by Ucla08 (04/19/17 10:11 PM)

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