Recently Dx with Psoriatic arthritis and I’m told that before I can get a biologic, the insurance company will insist I try Methotrexate. I see horror stories about it. Anyone use it successfully and without the horrendous side FX I read about?
Never needed methotrexate, but I have known people who used it, with variable side effects and symptom abatement. For those of you who don’t know, it’s one of the oldest chemotherapy drugs, originally used (and still used) mainly to treat leukemia and lymphoma, and in MUCH lower doses for autoimmune disorders.
You would be given MTX in milligram doses. People who take it for cancer may get it in GRAM doses. Your doctor will know how to treat side effects.
I’ve been on methotrexate for lupus. I didn’t have any terrible side effects. The main issue was that it tamped down my immune system so much that what would have been minor infections ballooned into much worse infections. For instance, I got a UTI that almost immediately blew up into a bad kidney infection. Because of that, I went off it. I’m now in remission, so I have no plans to go back on it.
If you’re on it, you have to get blood tests to monitor your kidney and liver health. If you’re faithful in doing this and your doc is reading the results, you should be OK. I think it’d be worth a try.
Oh, and you can’t drink alcohol while on it, but hopefully that isn’t a deal-breaker.
I’ve been on MTX (20mg one day each week) for about 5 years, for rheumatoid arthritis (joints and connective tissue).
No side-effects to speak of. Maybe a slight propensity to mouth ulcers that take longer to heal, but no biggie.
They tell me to take a small dose of folic acid on each day I don’t take MTX, to mitigate possible side-effects. And now I’m down to 3-monthly blood checks.
Does it all work? I didn’t get a sudden improvement when I started the course, but they had already put me on a short-term steroid and an NSAID, which has continued. The only way I could tell would be if I stopped, which I’m not going to do!
Incidentally, I had two new knee joints last year (fixing osteo-arthritis, nothing to do with the rheumatoid, of course). Wound healing and recovery was fine, and they told me to continue the MTX before and after.
Oh, and I haven’t been told to strictly avoid alcohol!
A huge thank-you to the UK’s National Health Service, the Royal United Hospital and the Royal National Hospital for Rheumatic Diseases in Bath, which is near to my home. And to my local GP surgery (office) and the local NHS hospital.
They have provided all of the above care to me, naturally at no cost to me at the point of treatment. Of course, I have paid my contributions as a part of taxation, all my working life.
2 near neighbours are also on MTX: one for RA like mine, the other for Krohn’s. Both would rather not find out if their treatment is working, by stopping!
I’ve prescribed MTX for a lot of patients, and managed them too. It’s a VERY good drug and very effective, as long as the patient is educated about risks, and monitoring is ongoing. Yes, there can be problematic side effects, but that’s true of any immunity-modulating drug. I had patients with worse reactions to the biologics (Humira, etc) than MTX.
Don’t fear, just be aware and informed. It’s far more likely to help than harm. And most of the likeliest harms that can occur do resolve after the med is stopped.
A relative took MTX for years to treat rheumatoid arthritis. It worked really well for a long time, with no significant side effects, but eventually stopped working so they had to switch to an infusion (Remicade). A neighbor recently started MTX for another form of arthritis & though it took a while to be effective, has provided much relief. MTX seems to be a good example of that statement on drug info labels about “…the benefits of this drug outweigh the risks”
I’ve had this for 30 years. It got progressively worse and I’ve been on MTX for at least 15 years. As a doctor once told me: any medicine that does good in one part of you has the potential to do harm somewhere else. With that said - take the medicine and follow protocol. The biologics aren’t magic bullets and MTX does a a lot to help with the pain and everything else that is horrible with autoimmune diseases.
Since I live where there’s universal health care, I’d like to say that even though your insurance company saves money (MTX is cheap), they are right in saying you should start with MTX. That’'s the way it’s done over here, where there is no stingy insurance company.
Mrs. Geek was on Methotrexate for a while. It made her tired and nauseous, but those were the only side effects. I wouldn’t call it “horrendous”.
YMMV.
Even if a correct decision, it’s a decision that should be made by the doctor and the patient, not the insurance company.
This. I have a friend on it for her rheumatoid arthritis. She follows the rules and is doing fairly well. She recently had successful knee surgery with no infection. She immediately masks up in questionable situations.
I tried Methylprednisolone just once and got a huge psoriatic reaction, so I’m steering clear of steroidal drugs as long as I can. I have a combination of psoriatic and bog-standard osteo arthritis. But, unlike my friend, I have skin that reacts to dietary and lifestyle changes.
Thank you. The reason I (and my dermatologist) suspect psoriatic arthritis, is that I am, and have been on a biologic for almost 5 years for severe scalp psoriasis. In my case Skyrizi which has worked wonderfully on my scalp. The dosing of Skyrizi is approx. every 120 days. About 4 months ago, I was noticing aches in (amazing to me) the tops of my feet and my hips. And I noticed that the pain went away after I injected the biologic. I forgot my injector before we went on a recent trip and was in pain on the plane and when I got home, I tried to walk the neighborhood while the medication warmed up and almost cried from the pain. I injected and the pain went away within hours.
Now I am reading that Naloxone is thought to help as well. I’d hoped to just go from Skyrizi to Humera (which is supposed to be the best for psoriatic arthritis), but the appointment setter told me that more than likely I’d have to start with Methotrexate. I feel a little better. Hope I still can have a drink!
(bolding by Carnut)
Okay, I’m looking into this now. I’ve been using Clobex which eases the itching (for the two weeks on) and then the second week off it, my scalp is already a mess again. Luckily, it eases for me in summer.
Please note the reaction I had included a rosacea flare up, too. but yeah, my scalp did not like the drug.
And that’s one reason why the OP is recommended to try a drug like methotrexate prior to going on a biologic.
I know another woman who has RA, and at one time she was prescribed azathioprine, another immunosuppressant that is still commonly used after organ transplants. She couldn’t believe how wonderful she felt on it…until she had blood work as ordered, just days later, and she was on the verge of liver failure. She later used Humira with excellent results; IDK what she may be using now.