Spondylitis Association of America Forums General Discussion General Message Board for Ankylosing Spondylitis and Related Diseases Effectiveness of injectable methotrexate

Has anyone found that moving from methotrexate tablets to methotrexate injection made a significant difference to its effectiveness? In my case taking 5mg folic acid six days a week keeps the side effects at bay, so the only reason to change would be to get more benefit.

My disease isn't that well controlled at present and my rheumy said the injection can be more effective than the tablets for the peripheral aspect of AS, although it still won't help the rib and spinal inflammation. The methotrexate tablets do help my hands in particular, but I've been having trouble with wrists, knees, ankles etc as well as spine and ribs. I moved from humira to enbrel in May and it didn't seem to be any more effective - and seems to be even less effective the last couple of months. CRP was 20 earlier this month - this is the highest it's been while taking humira or enbrel. The other option is to change to remicade and it may come to that.

For 4 months I took the oral MTX along with weekly Humira and developed subsequently worse and worse D(iarrhea) and GI upset. When I switched from oral to injectable it was like the clouds parted and the sun shined through. The difference from PO to injectable was significant. We did make an increase from 20 to 25mg. But I cannot get above 20 without serious nausea and sweating.

If your rheum is willing to try injectable, I would say go for it.

Thanks Supernova. just to clarify - did it help your AS symptoms more as well as having less side effects?

From what I have heard other folk saying on other message boards, you can end up tolerating much higher doses of MTX with injectable form than tablets, so I guess that would be the main benefit.

It certainly made a difference for me. There are FWIW a number of studies that have found the same.

Hi Shirley Yes, adding the MTX definitely made a difference. Also, I get vessel swelling across my nose and scalp and it is near-miraculous for this.

Thanks guys. Even my fingers are getting niggly now and they're usually well controlled by the mtx. So it might be worth giving the MTX injection a go. Cemc I dont think my rheumy will increase the dose from 20mg per week which I tolerate quite well - the idea is that the injection can work better.

Hi again Shirley,

I'm not sure I answered your second question. Yes, if I could have bypassed taking PO MTX from the start and just taken injection I definitely would have. It was not an option. This is all in hindsight. BUT my intestines are off-limits in general unless absolutely necessary.

So yes, the injection consistently (I love predictability) helps my AS sx as well as having less side effects compared to PO. Before I inject, I just look at the vial of liquid (which is honey colored or gold) and wonder what the heck it does in my body that makes it so effective?

Hopefully my 3 responses actually answer the question Take care, SN

I just want to quickly add my preference for injectable MTX. I too have needed a larger amount of folic acid to overcome the side effects from oral MTX. I take 5mg/daily 5 days a week. Even then, I was regularly getting small sores on the soft palate and tongue. Injectable MTX has certainly lessened it.

I don't think the MTX has significantly helped with my peripheral issues, thus we've recently added leflunomide to the mix. I'd probably stop it, but MTX is a requirement under the PBS unless contra-indicated while on infliximab.

The injections are a slight inconvenience, but I think we're all pretty used to being poked by others and/or poking ourselves by this point.

My understanding is that with pills the amount of mtx you absorb through your digestive tract can vary, whereas injections go directly into you system. That's why injections are seen as more effective. Hopefully someone will correct me if I'm wrong.