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Living with Psoriatic Arthritis (PsA)

Has Mtx Helped anyone?

#1

Hi,

I'm getting al little depressed, my knee has been in chronic pain for almost four months, it's difficult to walk and I'm at my wits end.

I'm going to start MTX this weekend. My question is has anyone been helped by it?

Most of the posts I've read, I haven't seen anyone who has said mtx has helped with pain, mobility and/or bringing the swelling down.

I haven't taken anything drug wise yet for my PsA, but it looks like I need to start.

Would love to hear from anyone on this.

Thanks,

tb

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#2

HI TB,

I'm on MTX but just started on Saturday Feb. 2nd. So I've only had two dosages and can't really tell yet. I'm also on prednisone and 2400mg of Ibuprofen, so I'm really not sure which one is doing the most good or if they are working in concert together. When I posted this question, someone said they think it's the high dosage of Ibuprofen that's bringing me relief. It's mainly my knees that are my problem as well!! That and the scalp psoriasis. I've been doing pretty well since last Wednesday night. From what I understand, some insurance companies require the doctors to start with MTX BEFORE moving on to the biologics. I suppose this is not true of them all, but my doctor said this to me and that he doesn't think the MTX will work for me, but that we have to start here. Perhaps that's why he also gave me the prednisone and the high Ibuprofen meds. I really don't know. I have a follow up appointment on the 19th and will let you know further at that time. I do sincerely hope you get relief soon!! Best wishes! :-)

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#3

Try to get the injectable form of MTX. But, take FOLIC ACID no matter what! You can play with the amount(mg) but, I was taking 3mg when I took MTX.

I quit taking MTX because it made my symptoms worse and I had more side effects from the MTX.

side note> I've been on Enbrel forever. I wanted to add mtx but, it didn't work.

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#4

I was on MTX for several months along with sulfasalazine and folic acid and it did help my pain and swelling a little bit. I started on 3pills/week and the difference wasnt too big so it was increased to 6 pills/week. This helped a lot more with the pain but the side effects were not worth it. I had severe fatigue, so bad I would get home from work at 6pm and go to bed until I got up for work the next morning. My appetite disappeared and while I lost some weight it was horrible. I had a bunch of other small symptoms and stopped it eventually. I think for a lot of us MTX has more side effects and bad consequences than good. I am now on leflunomide and enbrel butits too soon to see how they are working.

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#5

I'm on mtx and plaquenil at the moment. I find that it didn't help with pain much (saying this, I also have fibromyalgia), but it has kept my blood inflammation markers down. I take 5 mg folic acid twice a week, so thats been helping to keep the side effects at bay. It's a good choice if it works for you, plus it's a lot less expensive than the biologics.

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#6

That's what I've been hearing mtx isn't really helping and it seems to be in conjunction with something else.

Enbrel seems to be the one everyone agrees helps. Does it work on it's own or does it need to be with something else?

What side effects have anyone experienced with Enbrel?

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#7

I have found that Ibuprofen helps with the pain. But my knees is swollen, not sure if it is from having a massage therapist bend it around, I'm thinking that wasn't a great idea. Are your knees swollen? And the 2400mg a prescription from your rhuemy?

Sherry said:

HI TB,

I'm on MTX but just started on Saturday Feb. 2nd. So I've only had two dosages and can't really tell yet. I'm also on prednisone and 2400mg of Ibuprofen, so I'm really not sure which one is doing the most good or if they are working in concert together. When I posted this question, someone said they think it's the high dosage of Ibuprofen that's bringing me relief. It's mainly my knees that are my problem as well!! That and the scalp psoriasis. I've been doing pretty well since last Wednesday night. From what I understand, some insurance companies require the doctors to start with MTX BEFORE moving on to the biologics. I suppose this is not true of them all, but my doctor said this to me and that he doesn't think the MTX will work for me, but that we have to start here. Perhaps that's why he also gave me the prednisone and the high Ibuprofen meds. I really don't know. I have a follow up appointment on the 19th and will let you know further at that time. I do sincerely hope you get relief soon!! Best wishes! :-)

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#8

Enbrel, Simponi and Humiria only gave me partial relief for less than a year each. Remicade with mtx I have just started and it has been more promising so far. NSAIDs worked for me for years. I took Ibprofen, naproxene and diclofenac each for a number of years with good reduction in symptoms but the disease continues despite symptom reduction. Unfortunately it is impossible to tell if your PsA is going to be aggressive or not until it happens. Which is why most people end up on biologics; to halt the destruction of joints. Most of us have to start with mtx as for some people it will work for years. For other people they will have move onto biologics and if it is really stubborn (like mine) it will have to be NSAID and mtx and biologic to even get a partial remission. Ibprofen is over the counter in USA. I took 4 of the OTC tabs (200 mg each) 3 times a day= 2400 mg or max daily dose. I also took Tylenol 1000 mg 4 x a day, also max dose. Does not reduce swelling but did help with the pain. Luckily I have a good liver and the MD kept an eye on my blood work. Now I take 400 mg of Celebrx a day which is twice the daily dose but it does help. You will have to work closely with your Rheumy to find what works for you. I hope your journey is a short and successful one.

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#9

I think I may need to get the injectable form of the MTX. So far I can't tell if it's doing anything. I haven't had any side effects though on either the MTX or the Ibuprofen. So far so good I suppose. But now my right knee is swollen and feels like pressure. It's swollen just above it toward the outside of it too. I wonder what that means? I'm just glad it's not really pain anymore, just really annoying pressure. I'll find out Friday at my Rheumy appt. Thanks for letting us know (those of us who didn't) about the injectable MTX! :-)

Robert said:

Try to get the injectable form of MTX. But, take FOLIC ACID no matter what! You can play with the amount(mg) but, I was taking 3mg when I took MTX.

I quit taking MTX because it made my symptoms worse and I had more side effects from the MTX.

side note> I've been on Enbrel forever. I wanted to add mtx but, it didn't work.

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#10

Hi TB. Yes, the 2400mg Ibuprofen is a prescription from my Rheumy, and YES my knee is swollen too!! I haven't been to any massage therapists or had anything done to it other than just the usual movements in the daily course of living - walking, getting in and out of the car, standing, sitting, (Ok I did try to salsa a little one night while listening to some music at home, but that was literally all of 3 minutes.) But it's been swollen for about a week now. I notice that it seems to become more swollen as the day progresses so that by the time I get home I'm ready to just crash and relax. I can't wait until my appt so I can explain this to him and see what he says. I really like my doctor. He takes time to explain everything and give me reading material, etc, has excellent listening skills, etc. I feel very fortunate. I'll let you know what he says. I read online something about synovium or synovial fluids building up in the knees??? Not sure, but when I get back with you I'll have more information.



tb said:

I have found that Ibuprofen helps with the pain. But my knees is swollen, not sure if it is from having a massage therapist bend it around, I'm thinking that wasn't a great idea. Are your knees swollen? And the 2400mg a prescription from your rhuemy?

Sherry said:

HI TB,

I'm on MTX but just started on Saturday Feb. 2nd. So I've only had two dosages and can't really tell yet. I'm also on prednisone and 2400mg of Ibuprofen, so I'm really not sure which one is doing the most good or if they are working in concert together. When I posted this question, someone said they think it's the high dosage of Ibuprofen that's bringing me relief. It's mainly my knees that are my problem as well!! That and the scalp psoriasis. I've been doing pretty well since last Wednesday night. From what I understand, some insurance companies require the doctors to start with MTX BEFORE moving on to the biologics. I suppose this is not true of them all, but my doctor said this to me and that he doesn't think the MTX will work for me, but that we have to start here. Perhaps that's why he also gave me the prednisone and the high Ibuprofen meds. I really don't know. I have a follow up appointment on the 19th and will let you know further at that time. I do sincerely hope you get relief soon!! Best wishes! :-)

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#11

HI, you will read the side affects, hear others who cannot take it. But there are so many meds available now, compared to 40 yrs ago..aspirin regimen gave bleeding stomachs.

I would say about 80% of patients take it, it's been around since the 80's.....and no where near a real chemo patients dose.

You might read of others bad experience with it, but not everyone reports the good side of it...and remember there are other meds also to try..Always take folic acid with it

I am on it 18 yrs, without it, say after 2 months when it exits my system...I can't even do personal grooming, brush hair, toiletpaper, shampoo hair..so i do well with it..

At least give it a try......Just remember it can take up to 3 months to work...Also, i have had soem good luck with fish oil, to help swelling in the hands

take care

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#12

Methotrexate (MTX) is the drug that has helped me the most. It has helped significantly with pain, completely reduced swelling and brought me back to near-normal mobility from a point when I sometimes needed to use a wheelchair.

I had the opportunity to see this when my rheumatologist wanted to see how I did on just one of the medications I was taking - methotrexate and Enbrel. I did not take methotrexate for three weeks and before I'd been off of it for two weeks I started a major flare. By three weeks on Enbrel alone I had difficulty walking - my right foot is the most severely effected by PsA - and pain, stiffness and swelling in other joints: hands, feet, hips, knees, spine, my rib cage. Back on methotrexate, these symptoms went away. My rheumatologist took me off of Enbrel - I'd tried it for over three months - and I'm now at the beginning of experimenting with Humira.

All of these drugs require patience. Methotrexate, like the biologics, doesn't provide the sometimes same-day relief a person gets from a steroid. It took months for methotrexate alone to gradually improve my symptoms.

A number of well-designed studies show that when both methotrexate and a biologic are used together, PsA people get better "scores" on a wide range of ratings, including their own reports of how they feel, their doctors' evaluations of their joints, blood markers of inflammation, x-rays and/or MRI images that show what's happening, and so on.

Some people experience nausea or get a funny taste in their mouths the day after taking MTX, and some people feel fatigued. As several people have mentioned, folic acid, and/or a medication called leuflunomide can eliminate these side effects. Starting with a smaller dose of MTX and working your way up to a clinical dose gives the body a chance to adapt to whatever will be the therapeutic dose - the dose that's as much, but not more, than what you need. A lot of us take our MTX on Friday night or another night when we can arrange to do some less demanding things the next day and maybe schedule a nap.

MTX can be taken as tablets. It can also be taken as an intra-muscular injection that's no big deal to do yourself. The advantage of an I.M. dose is that it bypasses your stomach, so you get more of the drug into your system because it is not destroyed in your digestive tract. Injectable can also be the route for people with a degree of nausea that they find hard to handle, but at a high enough dose, the injectable can also cause nausea.

A big plus about MTX is that has been in use for decades. I remember that it was one of the chemotherapy drugs (in a much, much larger dose) that my father-in-law took over forty years ago. If MTX had serious long-term side effects like making you grow wings or putting people who used it at an increased risk of heart disease or cancer, that would be totally clear by now. The first biologics were approved for use in the early 1990s, and some much more recently, so less is known about their long-term effects.

Everyone is unique, but for a lot of us, it makes sense to start a treatment plan by seeing how methotrexate does for us, because it is pretty safe and very inexpensive. I think sometimes the biologics are like bright, red, shiny, new cars to some rheumatologists and some PsA people. It IS truly amazing to have drugs that actually get inside cells and reprogram them to behave themselves. If I were a rheumatologist I would probably prescribe biologics for all my patients - because they are so exciting. (Actually, I wouldn't, because I'm very conservative as far as medical matters go and believe in a phased approach.)

Good luck with your health.

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#13

I've been on MTX since September 2011. I currently take 20 mg. once a week. My joint swelling has decreased and my joint function is much better. I use to take a 500 mg of etodolac twice a day to help with the pain however since I added 2000 iu of fish oil each day I no longer need the etocolac at all. My rheumy tried to decrease my mtx however when I decreased the dosage to 15 mg I started to have pain again.

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#14

It's interesting to hear everyone's experiences. A good reminder that we are all different and that different things are going to work for us.

Glad your joint function is a lot better, Milo's my dog. I also take fish oil.

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#15

I just started Mtx on Friday. 10mg in combination with Humira 40 mgs weekly. Im feeling a difference already. My pain level is significantly lower. i was very excited to add this. Although, on Monday I had a sever IBS flare landing me in the ER. I have an appointment with my GI tomorrow and my rheumy in 3 weeks. I dont know if the meds are connected as I had an IBS flare last month when I wasn’t in it. Im sure all the additional meds are doing a number on my belly but im happy my joints are burning or throbbing anymore.

Good luck and I hope you find what works for you.

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#16

I've taken methotrexate for three years, and it really helped me a great deal for the first two and a half years. I was taking 8 pills a week, Friday night, and other than some nausea on Saturday, I had no issues with it. I will probably have to change meds at my March appt. with the rheum, but honestly, until the last while, mtx did me well. It took down the swelling in my Achilles tendons, helped with joint pain, and more...

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#17

glad to hear from someone who it helped. was mtx the only drug you were taking? I just want to be able to function for work, at least a little while longer.

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#18

Yes MTX is the only rx I'm taking. In addition I also take 2000 iu of fish oil (decreased my pain tremendously), 1 mg folic acid (helps with the side effects of the mtx), 20,000 iu of d3 (low vit d levels are common with PsA), and a good multi vit.

I use to walk my dog for around 4 miles a day, worked full time, did everything around the house. By the time I was diagnosed I could barely walk to the end of the driveway, was up all night with pain in my hand and foot, couldn't knit, and could barely type. Since my job is computer based the not inability to touch type was awful.

Within 4 months on mtx and etodolac things had improved just a bit.. After 10 months I had a lot of my lost function back. Currently things are good which of course can change at any time. It's really a one day at a time disease. No 1 size fits all cure to help with the effects of PaS. Very frustrating to not be able to do things at times.

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#19

Another question. I’m about to start mix tomorrow and I know it takes weeks to start feeling the effects, in the mean time what can I take for the pain? I was taking Advil, but because that is an NSAID, I shouldn’t , I also started taking Tylenol Arthritis pills, is it ok to take these until mix kicks in?

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#20

I got first results of reduced inflammation at 3 weeks. This is my first meds. for PsA. Expect more as the target date of 9 weeks approaches.

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