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Methotrexate: please share your experience #281562
09/30/18 07:19 PM
09/30/18 07:19 PM
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seymour Online OP
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Ok so long story short my biologic is working very badly and I want to switch but I think my rheumy will want me to try MTX before.

Two questions for you MTX users out there:

1- For those with peripheral arthritis like shoulders, ribs, hands, feet, etc., did MTX help you control your pain effectively?

2- For those that take MTX to "boost" an ineffective biologic, did you achieve significantly better pain relief when combining both meds?

A big thank you to all! smile

seymour

Re: Methotrexate: please share your experience [Re: seymour] #281563
09/30/18 08:42 PM
09/30/18 08:42 PM
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When I was first diagnosed with spondy, I had terrible chronic tendonitis in my right elbow and forearm. NSAIDs had done nothing for it. When my rheumy diagnosed me, she put me on yet another NSAID, but also added MTX. The MTX brought my arm pain down to an occasional nagging ache when I would overdo. So yes to #1.

A year or so later when she added Humira to help with lower back pain, she kept me on the MTX. So I can't answer #2 because I've never taken Humira alone.


Ginny - 57 year old female
Dx with USpA in March 2013; changed to AS in July 2015
Iritis and Scleritis
unicompartmental knee replacements: right-June 2014, left-Aug 2018
MTX, Humira, Cyclobenzaprine, plus Celebrex as needed
Supplements: Folic Acid, Vitamin A, Vitamin D, Calcium, Fish Oil, Culturelle probiotic, Melatonin (as needed)
Re: Methotrexate: please share your experience [Re: seymour] #281574
10/02/18 01:06 AM
10/02/18 01:06 AM
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seymour Online OP
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Looking for more experiences please.

I'm mostly wondering if it's worth it and if it's even possible for MTX to boost my Enbrel effect back up or if I'm just wasting my time

Re: Methotrexate: please share your experience [Re: seymour] #281575
10/02/18 01:25 AM
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seymour Online OP
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I mean once my biologic has lost effectiveness is it too late for MTX to help?

Re: Methotrexate: please share your experience [Re: seymour] #281576
10/02/18 01:31 AM
10/02/18 01:31 AM
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Sorry, MTX didn't help me and made me retch. I had two trials of it. It was pure poison!


Dx. reactive arthritis with recurrent uveitis, HLA-B27+ (1993), polymyalgia rheumatica (PMR) added in 2008, trigeminal neuralgia added in 2009

Hx. cataracts (2009), tendon rupture-wrist (2010), HTN with LVH (2011), pulmonary embolism-multiple, extensive and bilateral (2012), total bilateral knee replacements (2015), craniotomy for microvascular decompression of trigeminal nerve (2016), surgery pending for L4-L5 disc bulge, stenosis and severe "degenerative" spinal arthritis (2016)
Re: Methotrexate: please share your experience [Re: seymour] #281577
10/02/18 02:18 AM
10/02/18 02:18 AM
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My son is on MTX for his peripheral spondylitis. It has been quite effective and kept his significant knee inflammation in check. Initially he felt quite tired and mildly nauseous the day and/or day following his dose, but his doctor kept upping his folic acid and eventually that did the trick. Now he barely notices any side effects.


Karen
Female, early 50's, HLA B27+, family history of SpA
Diagnoses: USpA (9/17), limited Scleroderma/Raynaud's phenomenon/Sjogren's syndrome (1/16), stroke (8/15), Factor V Leiden (8/15)
AS symptoms: right heel enthesitis/tendonitis; elbow tendonitis; mild low back/buttocks and hip pain/stiffness; normal MRI
Treatment: Cosentyx; Xarelto; vitamins D3, B12, folate
Primary non-responder to Enbrel
Re: Methotrexate: please share your experience [Re: seymour] #281580
10/02/18 02:21 PM
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Hi seymour, I can't answer your question as i've not been on MTX however my cousin had psoriatic athritus and I know it cleared up her skin and stopped the joint pain. I recall she couldn't drink or certainly stopped drinking. I've read somewhere MTX is good for peripheral joint pain (user experience on this forum I recall).

I think i'm in a bit of a similar situation to you it sounds......I'm on humira (6 weeks now) and finding it's not touching the joint problem in my left finger (thumb only) and left toes. Interestingly I think these have started in the last 6 weeks, along with my elbows randly locking, cracking and aching a tad when extended.
My psoriasis on my face hasn't fully cleared either, although very much improved. I tend to find humira works a few days after the injection and then slowly returns. I have a similar issue with my back, where the pain starts to ease, but then it begins to return more severly usually around day 4-5. I was told by the rheumy that the biologic should address the peripheral joints (it hasn't) and skin and as such I'm assuming humira is either not strong enough or i'm not having the full affect of the drug. I've got an appointment next week and I'm thinking he might either change my biologic or get me on a disease moddifying drug like MTX. It's a shame we all react so differently to these drugs.

By the way, my cousin was on MTX and I'm sure she couldn't drink alcohol on it. Also my mates mother was too and they took her off it (she has RA) because it screwed up her liver. I know biologics aren't very nice, and although I can't say I have strong evidence to sugget otherwise, I'm concerned about going on a drug like MTX. I'll be pushing for a different biologic personally.

Re: Methotrexate: please share your experience [Re: pdiddy] #281582
10/02/18 03:54 PM
10/02/18 03:54 PM
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MichaelSean Online
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Originally Posted by pdiddy

By the way, my cousin was on MTX and I'm sure she couldn't drink alcohol on it. Also my mates mother was too and they took her off it (she has RA) because it screwed up her liver. I know biologics aren't very nice, and although I can't say I have strong evidence to sugget otherwise, I'm concerned about going on a drug like MTX. I'll be pushing for a different biologic personally.


My rheumatologist couldn't put me on MTX because my AST and ALT scores (liver enzymes) were on the high side. Not crazy high but just outside the standard range. Interestingly, since starting Humira both of those scores have dropped into the 20s, safely inside the normal range. My PSA (prostate specific antigen) dropped under 2 as well.

I get the nervousness about biologics. I've felt it, too. For a while I was paranoid about cancer. But beyond helping with the joint and neck pain (which is now completely gone) I feel Humira is helping my body in unseen ways as well. It's not ALL rainbows and lollipops, however. When I get sick it tends to linger for a really long time. That's the trade off.

Re: Methotrexate: please share your experience [Re: seymour] #281587
10/02/18 06:58 PM
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seymour Online OP
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I looked all over the Internet for data on adding MTX to a biologic DURING treatment to boost its effect but I haven’t found anything. All I find is data on prescribing MTX alongside a biologic to sustain response, but nothing about enhancing response once it becomes less.

Re: Methotrexate: please share your experience [Re: seymour] #281591
10/02/18 08:58 PM
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Adding MTX to biologic treatment when the biologic is becoming less effective is usually done because the patient has developed antibodies to the biologic. MTX helps reduce the production of the antibodies.

Add the word antibodies to your search and you should find some papers on the subject.


Ginny - 57 year old female
Dx with USpA in March 2013; changed to AS in July 2015
Iritis and Scleritis
unicompartmental knee replacements: right-June 2014, left-Aug 2018
MTX, Humira, Cyclobenzaprine, plus Celebrex as needed
Supplements: Folic Acid, Vitamin A, Vitamin D, Calcium, Fish Oil, Culturelle probiotic, Melatonin (as needed)
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