Starting Methotrexate, Prednisone together?

[Jomox]

Hello, I hope I have posted in the right place on the forum now.

To cut a long story short, I have just been diagnosed with Spondyloarthropathy through private insurance after the public health care could not find what was wrong with me for well over a year, conditions: ankylosing spondylitis / psoriatic arthritis but my doctor said I have like a mixture of all of them as I have many symptoms, and am suffering from many pains (back, sides, foot, buttocks, breathing, finger swelling, nail coloration etc) and have finally found good doctors through private insurance who have found this (I am in Spain) I also have some sacroilitis.

The first Rheumatology doctor prescribed me with prednisone 10mg for 2 weeks, (2 weeks 10mg, 1 week 5mg) I felt nothing at all, and I had 1 week not taking these before visiting my new Rheumatology doctor who is helping me allot more, she is suggesting I go on the bio treatment but first wants to try these first steps.

I was prescribed the 15 Methotrexate injection and inacid retard 75mg (1 day and night) yesterday and have not taken Methotrexate yet.

I started on the inacid last night and was fine, but after the second dose in the morning of the inacid, after 1-2 hours, I started to feel terrible, very dizzy and could not breathe, and was almost passing out, I was very bad and went to the hospital.

The hospital did checks on my heart, and lungs, while the results came back fine they got me an appointment set up with a Pulmonologist to find out why I am having breathing problems/chest pains. (I have listed all my symptoms below) and the doctor there talked to my Rheumatology department and prescribed me to take prednisone 30mg, and to go back to the hospital tomorrow to have the Methotrexate injection.

But after reading, is this the right way to go about things? I have heard prednisone 30mg & Methotrexate is quite high? I have not started any effective treatment yet but I am worried about serious side effects after already suffering very bad effects from the inacid retard 75mg.

What do you recommend I do? Go back to 10mg prednisone with the Methotrexate? Or just try the Methotrexate alone? (I have the folic acid day after pill also and stomach protection)

I also forget to mention I was once taking mirtazapine for a few years and it caused a bit of fatty liver, so my ALT levels are often a little raised, is this something we should be taking care of and how do we get around potential liver damage taking these meds.

The doctor at the hospital also said I need the injection and to get started as it is the one that's going to really help fight my inflammation I have and do the most work, and Prednisone is mostly for the pain.

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General Symptoms

(Possible spondylitis – grandfather and two uncles also diagnosed but don't have all these symptoms only the spine mostly)

Back, Ribs & Neck Pain:

Pain on the left side of my ribs originally

Pain went to my right side and then to my back

Pain in the neck for the last 4 weeks

I cannot sleep on my side without bad pains on my sides

I struggle to move my head side to side and can’t move side to side properly

Chest/Lungs:

Chest/heart pain sometimes

I have shortness of breath/breathing problems sometimes, worse when lying down

The breathing problems are sometimes very bad, I struggle

Weird sounds around my heart sometimes (creaking and like water noises)

Legs, Feet & Buttocks:

Pain on the sole of my left foot (worse after lying down or sitting, but also when walking and with pressure)

Alternating Buttock pain sometimes (Top of legs)

Hands/Nails:

Weird fungus on my nails, fungus treatment ineffective

Swollen thumb and fingers on my right hand (Sometimes painful)

My very far left finger on my right hand is a little bent (little finger)

[Happyrosie]

I think, Jo ox, that as we are not medically trained here it would not ne appropriate for us to comment on what consultants have prescribed for you. Other posters here may disagree with me,

[piglette]

A lot of people with PMR - Polymyalgia Rheumatica take methotrexate and prednisone together also people with rheumatoid arthritis, plus others as well.

[Alex-1]

Hi its tough but I would go with DRs recommendation.

[kateanne]

There is a really good forum on this site for rheumatoid arthritis. If you join that, you'll find loads of useful posts about methotrexate and prednisone as these are the standard medications for that condition. You don't need to have RA to join but it may be more informative to read.

[Whystar]

Hi, newly diagnosed (and totally flattened with a flare) PsA, enthesitis, spondylarthropathy, scoliosis, etc etc etc. like you in prednisolone but 20mg for a month then reducing over a further 2 whilst I start methotrexate and hopefully a biologic. I feel your pain, literally. 20mg prednisolone is barely touching the sides…I’ve not been on here for months but should be popping in more often (note to self!)…

I can’t answer your Qs but wanted to reassure you that you’re not alone.

Do join the Psoriatic arthritis Facebook groups too, amazing bunch, just like here. People like us who understand us!

Good luck, Wx

[Jomox in reply to Whystar]

Thanks for the reply and support. I am on 30mg pred but I have a feeling it's just not going to work especially with the bad pain on my foot, maybe it will help relive some back/side pain, I see the doctor again on Tuesday and need to make a new plan I think, she tried me on the inacid probably as she knew it was better but I am intolerant it sadly.

[Whystar in reply to Jomox]

I honestly know the feeling. It’s exhausting managing this isn’t it? I’m allergic to all NSAIDs so my treatment is proving difficult 😥 xx

[Hidden]

Hi there I’m so sorry that you’re having such a rough time! I’m not sure about Prednisilone as I’m not on that. I take 15mg Methotrexate Injection then 3 days after Folic Acid Tablet. The Methotrexate certainly helped dampen down some of my symptoms. I now also take Amgevita injections every two weeks. These two injections are meant to be very effective together. Meant to tackle inflammation well which I’m turn helps with pain. However I’m not sure if they’re having all the desired effects. I still have crippling sore back, fingers and toes with Dactylitis after 3 months! I hope they can get you sorted out. Sending big hugs and love to you 🙏🏻🍀💔😘xx

[Mikmax]

Hi Jomox really sorry you are having such a bad time. I suffer with Crohn’s disease but also associated arthritis . I think it’s best to go with what the drs have prescribed for you, I know it all sounds a bit hardcore but in my experience they like to get the inflammation under control first then when you have stabilised they will cut down on the steroids and methotrexate and hopefully then you will migrate onto biologics and they will keep things stable going forward. Good luck and hope you feel better soon

[Mikmax]

Also wanted you to know that I too had severe pain in my buttock that was diagnosed as gluteal tendinitis as well as my ankle (inner) and wrists. Basically it’s all part of the prognosis of Spondyloarthropathy which affects the tendons where they join onto the bone. I found doing very limited floor exercises a benefit and as well as NHS help I found these two American PTs on YouTube called ‘Bob & Brad’ and they are absolutely phenomenal! Just type in any issues you have and they will have a gentle exercise for it.

[Jomox in reply to Mikmax]

Interesting, I must have had the symptoms when I lived in England but was always classed as other things (Hamstring tendonitis / nail fungus / muscle pain) never any tests or suggestions of anything else (For years) Thankfully with the private insurance and now a good doctor getting treated well, wish you the best, thanks for the tips.

[Jomox]

Hi, just an update for everyone, generally feeling better, I think the pred is working and MTX slowly taking effect, my movement with my spine has improved and I can turn side to side almost normally without pain (Still can't sleep on my sides and general back pain of course still though) my foot still giving me problems for 70% of the hours in the day, but no pain on my fingers/hand really now, and the fungus on my left hand nails has completely gone, just some still on my right hand, along with swelling that seems to be slowly going down.

I am cycling to the beach every day, and swimming (taking it easy) I think it is helping allot with my.

I also got the newblood results back and my white cells are a mess, it looks like my immune system is very weak to infections etc, I'll post more about this later, (started lowering dose of the pred to 20mg today) got another appointment on the 13th, to talk about bio meds and what to do.

[Mikmax]

Great to hear you are moving in the right direction! Hopefully things will improve day by day

[Jomox]

Hello all, hope you are all okay,

I have a question about Prednisone and mood changes. I've started to feel lets say more "sad" inside and there's always a little aggression or anger inside me waiting to be unleashed. I am okay and handling it fine, but I just feel slightly depressed and not happy, and my partner can feel it, we went out last night as there was an event (i had one glass of red wine, I've not been drinking at all) and while my partner wanted to enjoy I just could not feel any joy, and my partner said I just looked sad/tired and not up for it, and we just went home, being boring.

I know why I was tired, because I wake up early and have allot of energy to do things in the day (while manage pains) so naturally during the evening after 9 I start to feel tired and like to relax at home, but the sadness/happy levels is different.

I have things to look forward to and be happy, but it feels like something is controlling my "Happy positive side" and I'm usually very positive and uplifted even if their is any kind of suffering in life.

I have some days left on 15mg, and then going to 10mg to taper of them, I'm just wondering if this is normal with pred? as I don't think it is the MTX?|

I have lung tests next Tuesday to make sure I'm not asthmatic to see about biologic treatment also, which could possibly start next month.

I tried sleeping on my right side last night also as I did not feel pain at first and was really tired, but now I am suffering with pains on my right side (around back/rib area) so sleeping on my back is still a must.

[marionofnorwich]

I guess it is worth remembering that you will be suffering from a combination of inflammatory and mechanical impacts one causing the other as we are like a load of stick bound together with elastic bands. Your foot problem is likely caused by other factors further up. Do you have orthopaedic foot inserts? They might help