Bronchiectasis/Rheumatoid Arthritis and Methotrexate

[Oldmuso]

I have bronchiectasis and rheumatoid arthritis and am being urged to take methotrexate but am concerned this could impact on regular chest infection’s. Does anyone have experience of this.

[cofdrop-UK]

This is one you really need to speak to your respiratory con about. It would be helpful if different disciplines could liaise and treat us more holistically. Good luck cxx

[Oldmuso in reply to cofdrop-UK]

Thanks - my chest consultant says it is something I might have to consider as the RA could cause problems with lungs - but it is hard enough to shake off any chest infections without my immune system being compromised - I am not convinced !!

[Oldmuso in reply to cofdrop-UK]

Many thanks

[Mooka]

I have taken methotrexate but didn’t get on with it. As you rightly say it will suppress your immune system. I’m immune suppressed through rituximab, I believe this is also used to treat RA. I had a torrid time with chest infections (I also have Bronchiectasis) until pseudomonas was identified. That is now controlled with nebulised antibiotics and I no longer have a problem. Would your rheumatologist be able to discuss with your Bronchiectasis doctor as cofdrop-U.K. has suggested. If you are immune suppressed your body can’t help too much with the infection and you are reliant on antibiotics. Good luck.

[Oldmuso in reply to Mooka]

Many thanks

[Izb1]

I too have r.a. and bronchiectasis and fought hard against taking methotrexate. I relented in the end as the pain was too bad. You have to weigh up whats best for you. I respond really well to a steroid injection but they are damaging in the long run, although at the time my argument was so is methotrexate. My biggest problem is having a weakend immune system and picking up any bug going. When having an infection you cannot take methotrexate. I am at a crossroads at the moment as the methotrexate isnt working well and they want me to go onto biologics which I dont want to do. If your condition is only mild and you dont have too many problems talk it over with your rheumy doctor and ask if you can delay this until you are sure its something you can deal with. I understand where your fears are coming from its not an easy decision x

[Oldmuso in reply to Izb1]

This is to say thanks again to all who have replied and commented - much appreciated.I have had bronchiectasis for more than 25 years and usually suffer 2/3 infections annually - most times I send in a specimen for analysis and of late the path. lab has difficulty in finding an anti-biotic as bugs seem to be resistant. For RA I take 7.5mg prednisolone and have just tried 4 months of sulfasalazine - I found the side effects very hard to cope with and there does not seem to be any effect on the RA, so I have now stopped taking this. I am apprehensive to start methotrexate due to the anti inflammatory effect on my bronch. and wonder about possible side effects. At 84 RA came out of the blue 18 months ago and quality of living is now very important at my age so I am wondering if just continuing on low dose pred. is not the best option.

[Izb1 in reply to Oldmuso]

I would ask about the steroid injections, they seem to be stronger and last longer, but whatever works for you is best. I dont blame you for not wanting to go onto methotrexate x

[Maricopa]

Methotrexate is a dangerous drug to mix with lung issues. Many have adverse side effects such as severe lung damage leading to gasping for air. I speak from experience. After on it for four weeks it began to affect my breathing. My rheumatologist told me to stop immediately. But my lungs never fully recovered. He referred me to my pulmonologist and I began taking Arava aka leflunomide. Hard to find safe drugs to treat arthritis when we have lung conditions. I really would not take methotrexate.

[Oldmuso in reply to Maricopa]

Many thanks for your detailed comments - I have some hard thinking to do.

[Caspiana]

Hello Oldmuso , 🌿

This is a very difficult choice. I was on methotrexate for years before I had my lung transplant. I don't know how long you have had RA but the guidelines to treat it have changed somewhat over the years. By the time I was diagnosed the guidelines stated that newly diagnosed patients needed aggressive treatment to stabilise the condition before it caused havoc with the joints, which would be , as you know, irreversible. Methotrexate is the gold standard; however, if it is contraindicated or not tolerated, sulfasalazine, hydroxycholorquine, minocycline, and leflunomide can also be used. I took it and it gave me no issues. I asked for the lowest dose possible. I am lucky not to have had any deformity in my joints thus far.

The only way you will know how it will work or not work, or cause side effects is to trial it. If your doctor is pushing for it it is clear she/ he thinks it is in your best interests as the long term effects of RA could lead to significant disability as you know, not to mention the possibility of the disease attacking other organs in your body.

If I were you I would have a talk with your doctor. Do your research, list the pros and cons and see what they have to say about it. Push them to tell you why it would benefit you and possibly ask about a monitored trial run. And then if you do not feel satisfied by with their arguments ask them the question I usually ask, "Would you prescribe it for your mother?".

We all have good advice and feedback , but ultimately we are talking about ourselves and our personal outcomes. We have no way to know how this drug would work for you.

Best wishes to you.

Cas xx 👋😃

[Oldmuso in reply to Caspiana]

Many thanks - I do appreciate your detailed comments - I have a follow up with my Rheum. Doctor in a few weeks. Meanwhile will continue with my daily pred. and will ask for all of the options. I have stopped the sulfasalazine after 4 months as the side effects are just too bad to continue. I have lots of thinking to do ! Best wishes.