Methotrexate

[amandajane76]

Does methotrexate help with fatigue

[lupus-support1 Administrator]

I am sorry for the delay in response. I was travelling all day yesterday and this is the first opportunity to respond.

I self-inject MTX weekly.

I hope this is of help.

With good wishes,

Ros

Immunosuppressives are medications that help suppress the immune system. Many were originally used in patients who received organ transplants to help prevent their bodies from rejecting the transplanted organ. However, these drugs are now also used for the treatment of certain autoimmune diseases, such as lupus and rheumatoid arthritis. In people with lupus, the immune system mistakenly attacks the body’s own tissues. Most immunosuppressives work to downregulate (suppress) this attack by interfering with the synthesis of DNA, the material in your cells that contains the blueprints for all of your genetic information. In doing this, these medications prevent the cells of your immune system from dividing. When cells cannot divide correctly, they will eventually die. The immunosuppressives prescribed most commonly for the treatment of lupus are azathioprine (Imuran), mycophenolate (Cellcept), and cyclosporine (Neoral, Sandimmune, Gengraf).

Immunosuppressive medications are used to control more serious lupus activity that affects major organs, including the kidney, brain, cardiovascular system, and lungs. Before prescribing an immunosuppressive medication, your doctor may perform a biopsy of the kidney or affected organ system to evaluate the most effective course of treatment. Sometimes immunosuppressive medications are given in addition to or instead of steroid therapy to lower the dose of steroids needed and thus spare some of the undesirable side effects of steroid therapy. For this reason, these drugs are sometimes called “steroid-sparing” medications or “adjuvant” (helping) drugs. Steroid-sparing drugs usually have a two-fold benefit, since they often reduce or eliminate the need for steroids while also improving lupus symptoms.

Because immunosuppressive drugs put down the immune system, people taking them are at an increased risk for infection. Try to stay away from people who have colds or other illnesses, and make sure to wash your hands regularly and maintain good personal hygiene. If you are also taking steroid medications, you may not realize that you are ill because the steroid may suppress your fever symptoms. Contact your doctor immediately at the first sign of any infection or illness.

In addition, immunosuppressive medications are known to increase the risk of cancer development later in life. However, lupus itself is also known to increase the risk of cancer, so by controlling your lupus now and preventing it from doing further damage to your body, immunosuppressive therapy may actually decrease your risk of developing cancer. Either way, it is very important to control your lupus activity now to prevent other potentially life-threatening complications.

Disease-Modifying Antirheumatic Drugs (DMARDs)

Disease-modifying antirheumatic drugs, better known as “DMARDs,” are immunosuppressive medications that are used to treat the pain and swelling of the arthritis that can accompany lupus. DMARDs not only reduce this pain and swelling, but they may also be able to decrease long term damage to your joints.

Methotrexate (Rheumatrex)

Methotrexate is one of the most commonly used drugs for the treatment of rheumatoid arthritis, and it is used in lupus patients to alleviate the joint pain and swelling of polyarthritis (arthritis involving multiple joints). It is only mildly effective for more severe lupus symptoms involving the kidneys and other organs and should be used carefully in people with these conditions. Historically, methotrexate has been used to treat cancer and psoriasis, a skin condition that can also affect the joints. However, in the late 1980s, the medication was approved by the FDA for the treatment of arthritis and has been used commonly for this ever since. Methotrexate works by interfering with the production of folic acid, which is a building block for growing cells in your body. As a result, methotrexate hinders the growth of certain cells, including those of the immune system. This medication is also steroid-sparing, meaning it can be used in conjunction with steroids to lower the dose of steroid therapy and thus also lower the associated side effects.

The medication is usually taken as a tablet in doses of 7.5 to 25 milligrams (mg) per week, but it can also be given as an injection. People taking methotrexate usually feel improvements in 3-6 weeks, but it can take up to 3 months to feel the full benefit of the drug. Be sure to take this medication as directed. If you miss a dose, you can usually take the medication up to 4 or 5 days after. However, if you miss this window, contact your doctor regarding how you should proceed.

Most people taking methotrexate do not experience side effects and many of the more minor side effects will decrease with time. However, the likelihood of these side effects does increase as your dosage goes up. Many of the side effects of methotrexate involve the fact that the medication works by interfering with the production of folic acid in your body. Therefore, your doctor will most likely recommend that you take folate supplements, which will prevent many of these side effects, including mouth sores (stomatitis). Other side effects may include nausea, vomiting, and an increased risk for abnormal liver function tests. Because of the danger to your liver, you should not drink alcohol while taking methotrexate; drinking while on this medication can cause irreversible damage to your liver. In addition, it is important that people taking methotrexate have normal liver function tests. Be sure to tell your doctor if you have a history of liver disease. In addition, lung problems, such as a continuing cough or shortness of breath, can occur while taking this medication but are more common in people with preexisting lung conditions. Talk to you doctor if you experience these symptoms.

Some patients experience gradual hair loss (alopecia), but hair usually grows back once you stop taking methotrexate. In addition, methotrexate can increase your sensitivity to sunlight. Since many lupus patients already experience sun sensitivity, try to limit sun exposure and be sure to wear sunscreen when going outdoors.

It is important to remember that sometimes the side effects of this medication can go unnoticed; sometimes people may have abnormal blood tests while feeling no side effects at all, so it is important to have blood tests (complete blood counts, or “CBCs”) performed every 2-3 months while taking methotrexate.

If you are pregnant, may become pregnant, or are breastfeeding, you should not take this medication because it can cause serious birth defects and complications during pregnancy. Women taking this medication should use an effective method of birth control. Speak to your doctor about any pregnancy plans or concerns.

As with other drugs that may suppress your immune system, talk to your doctor about any vaccines or surgeries you may have. In addition, be sure to notify him/her of any other medications, both prescription and over-the-counter, that you may be taking. Methotrexate can interact with certain drugs, including the antibiotic trimethoprim (Bactrim)* and NSAIDs such as ibuprofen (Advil, Motrin) and celecoxib (Celebrex). Do remember, though, that sometimes methotrexate may be used in combination with certain NSAIDs to treat lupus. Your doctor will work with you to determine which treatments will work best to treat your lupus symptoms with the fewest side effects.

hopkinslupus.org/lupus-trea...

Methotrexate is one of the mainstays of treatment for inflammatory forms of arthritis, including rheumatoid arthritis (RA) psoriatic arthritis and juvenile idiopathic arthritis, because it not only reduces pain and swelling, but it can actually slow joint damage and disease progression over time. That’s why methotrexate is known as a disease-modifying anti-rheumatic drug (DMARD).

“There are great data to show that it’s extremely effective and safe,” says Prabha Ranganathan, MD, an associate professor of medicine in the division of rheumatology at Washington University School of Medicine. “Most rheumatologists, once they’re convinced that a patient really has rheumatoid arthritis, will use methotrexate as first-line therapy.”

Methotrexate isn’t new—it’s been part of RA treatment for three decades. Researchers first developed this drug in the 1940s as a cancer treatment. Then in 1985, a study published in the New England Journal of Medicine showed that it relieved pain, swelling and other symptoms in people with RA. Three years later, methotrexate won FDA approval for treating RA, and it soon became the treatment of choice for people with this condition.

Methotrexate Dosing

Most people with RA who use methotrexate—and about 90% of patients with this form of arthritis do use the drug at some point—take it by mouth. Typically people will start with a weekly dose of 7.5 to 10 mg, equal to three or four pills. If that doesn’t help with symptoms, the doctor may raise your dosage to 20 to 25 mg per week, or as high a dose as you can tolerate.

When pills alone won’t calm your symptoms, your doctor might give you subcutaneous methotrexate—a shot given under the skin. Taking the drug this way puts more of it into your system without increasing side effects. You can administer methotrexate yourself using an auto-injector.

Pairing With Other Drugs

Methotrexate is effective, but not everyone who takes it gains adequate relief from joint pain, swelling, morning stiffness and other symptoms. “The rest of the patients need something else,” says Yusuf Yazici, MD, an assistant professor of medicine at the New York University School of Medicine’s Hospital for Joint Diseases in New York City.

Fortunately for patients who need more relief, combining methotrexate with other medications will usually do the job, says Dr. Yazici. Most often, methotrexate is combined with other DMARDs, such as leflunomide (Arava), cyclosporine (Neoral), sulfasalazine (Azulfadine) and hydroxychloroquine (Plaquenil).

In people who don’t respond well to a DMARD—alone or in combination—doctors may try combining methotrexate with biologic drugs. These drugs inhibit part of the overactive immune system response that contributes to RA. The most common biologic combination is with tumor necrosis factor (TNF) inhibitors such as etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade) or certolizumab pegol (Cimzia). These drugs block TNF, a protein that promotes inflammation and damages joints. “TNF inhibitors and methotrexate appear to be synergistic,” says Arthur Kavanaugh, MD, a professor of medicine in the rheumatology division at the University of California at San Diego.

All the biologics seem to work equally well in combination with methotrexate. Research also shows that methotrexate combines effectively with other biologics, such as abatacept (Orencia), rituximab (Rituxan) and tocilizumab (Actemra).

A Long Record of Safety

Methotrexate is widely regarded as one of the safest of all arthritis drugs, though it carries some potential downsides. Gastrointestinal symptoms such as nausea and vomiting are the most frequent side effects linked to the drug. Sometimes the drug will affect liver function tests, especially when it’s taken in higher doses. Your doctor will monitor you for liver effects.

Other possible side effects include hair loss, mouth sores, shortness of breath, headaches, fatigue, drowsiness and dizziness. Taking folic acid daily can help offset these problems. Certain people, notably women who are or may become pregnant, should not take methotrexate.

Methotrexate is one of the most effective and widely used medications for treating rheumatoid arthritis (RA). It’s also one of the safest RA drugs, insist rheumatologists, despite a common misconception among many patients and even some primary care physicians that methotrexate is highly toxic.

Confusion about this important medication’s safety profile seems to exist because it is also used — in much higher doses — for treating some forms of cancer. Most RA patients who use methotrexate take between 10 and 25 milligrams (mg) per week. By contrast, the doses used to treat leukemia and certain other types of cancer may be hundreds of times larger.

That’s not to suggest that taking methotrexate is risk free. A 2009 review of 21 studies found that 73 percent of RA patients who used the medication experienced at least one side effect. Yet the study indicates that most of these problems were relatively minor. What’s more, doctors who prescribe methotrexate for RA say that following a few simple steps can make this drug even safer to use.

Folic Acid Is a Must

Understanding how methotrexate works helps explain why it can cause unwanted effects. Researchers originally developed methotrexate in the 1940s as a cancer drug. It stops malignant (or cancerous) cells from rapidly multiplying and spreading by blocking their access to folate, a form of vitamin B, which these cells need to survive.

Unfortunately, depleting the body of folate can affect healthy cells, too, especially those in the gastrointestinal (GI) tract, mouth, hair follicles and liver, says Prabha Ranganathan, MD, an associate professor of medicine in the division of rheumatology at Washington University School of Medicine. GI problems such as nausea and vomiting are the most common side effects associated with methotrexate, affecting between 20and 65 percent of RA patients who take the drug. While hair loss is a relatively uncommon side effect in RA patients who take methotrexate, up to one third develop mouth ulcers, or sores. Many also complain of headaches, fatigue and an overall “blah” feeling — sometimes called “methotrexate fog” — that can occur a day after receiving a dose of methotrexate (which is taken in pill form or injected once a week).

The good news: These side effects can often be short-circuited by taking a folic acid supplement. Folic acid is the synthetic form of folate. One study found that RA patients on methotrexate who took folic acid supplements lowered the risk of GI problems and mouth sores by 79 percent.

Dr. Ranganathan recommends taking 1 mg of folic acid daily, though for convenience some other physicians instruct patients to pop a single 5 mg dose once a week. (Some doctors recommend taking folic acid 24 hours after receiving a dose of methotrexate; ask your physician for complete instructions on using folic acid supplements.)

A few additional steps may help prevent or relieve GI and oral problems:

Split the dose. Most RA patients take methotrexate orally, in a dose consisting of several pills. Some find that splitting the dose eases GI side effects; take half the pills in the morning and the other half 12 hours later, preferably with food.

Ask about medication. For very severe stomach queasiness, your doctor can prescribe an anti-nausea drug such as ondansetron (Zofran), says pharmacist James Bennett of Children’s Hospital in Boston.

Swap your pills. When nothing else helps, switching from oral methotrexate to the injectable version can eliminate GI distress.

Try a rinse. To relieve painful mouth sores, a salt-water rinse or special mouthwash containing lidocaine (a pain reliever) may help, says Bennett.

Protecting the Liver

Since methotrexate blocks folate, taking folic acid — the manmade version of the vitamin — might seem like it would be counterproductive. However, methotrexate appears to relieve pain and other RA symptoms through actions that are largely unrelated to folate, explains Edwin Chan, MD, a rheumatologist and researcher at the New York University School of Medicine. Dr. Chan and other investigators discovered that methotrexate causes cells to release a molecule called adenosine, which blocks other chemicals that promote inflammation.

Fighting inflammation helps relieve painful, swollen joints. But Dr. Chan notes that adenosine also causes fibrosis, or buildup of scar tissue, in the liver; over time, that could result in liver disease. Your doctor will run routine blood tests to monitor your liver function, but it’s worth noting that only about one in 1,000 RA patients taking methotrexate experience serious liver damage. Yet it’s important to note that alcohol also releases adenosine in the liver, says Dr. Chan. That’s why your physician may advise you to avoid booze while taking methotrexate in order to limit your risk for liver problems. In rare cases, methotrexate users may develop fibrosis and inflammation in the lungs, though this is unlikely to be related to adenosine release, says Dr. Chan. Report a dry cough, shortness of breath, or any other respiratory problem to your doctor.

Regular blood tests are also necessary to detect signs of other problems that can arise in methotrexate users, including a drop in white blood cells, which normally guard against infections. Also, some people experience a dip in production of blood platelets, which could cause abnormal bleeding. However, these changes in the blood often go away if you stop taking the drug temporarily (which should only be done under a doctor’s supervision).

Fear of side effects causes some primary care physicians who treat RA to prescribe methotrexate in doses too small to provide adequate pain relief, says Yusuf Yazici, MD, an assistant professor of medicine and colleague of Chan’s at the New York University School of Medicine. But most people tolerate the drug quite well, especially if they take folic acid and practice other good habits.

Says Dr. Yazici: “There’s no reason to be afraid of methotrexate.”

arthritis.org/living-with-a...

[amandajane76 in reply to lupus-support1]

Wow good reading.thankyou

[amandajane76 in reply to amandajane76]

Has it help with your fatigue

[Anabel in reply to lupus-support1]

Sorry hit the report button but this information would be great on my Fb page to help many. Please share

[lupus-support1 Administrator]

This is a difficult point to answer. I do not know. What I do know is that MTX works and I would be worse without it - not to mention having to take high doses of corticosteroids which affect the body.

If you feel tired - listen to your body - and rest. If you are up early in the morning, you may need to rest in the afternoon. Accepting rather than resisting is better for you.

With good wishes,

Ros