Methotrexate and azathioprine

[cakerbaker]

Having got to see my rheumatologist after a long wait I have now been started on methotrexate as well as azathioprine prednisolone and hydroxychloroquine. This seems a lot but I do still find I have trouble walking far and managing generally. Has anyone else had this combination? The consultant didn't tell me a lot although is very good. Thank you 😊

[SjogrensinTexas]

I take both Methotrexate and Hydroxychloroquine currently. And have to take Folic Acid supplement (rx not over the counter) because of the Methotrexate. Prednisone has only been prescribed to me as a short term "fix" and I have not required it since I went on the Methotrexate. Those 2 seem redundant so you may want to ask a pharmacist and see what they think. If doctor didn't prescribe the Folic acid you should ask as Methotrexate severely depletes it, I have been told not to go without it as long as I am taking the Methotrexate. Side note - I have also found that my hair was great and much thicker on the Hydroxychloroquine alone but has thinned noticably since adding the Methotrexate to get my inflammation under control. Just my personal experience.

[cakerbaker in reply to SjogrensinTexas]

Hi thank you. Not happy about the hair thinning as it's just growing back! Glad you improved on it though. Fingers crossed 🤞 Keep well

[LuluM25]

Hi Cakerbaker, I have changed from methotrexate to Azathioprine alongside hydroxychloroquine and Prednisolone during the last few months. I would agree with your feeling that normally you wouldn’t take Aza and Metho together and would query this. I stopped taking methotrexate after an AKI, sudden drop in kidney function, and Rheumatologist felt that may have been the cause. Thus it was substituted with Azathioprine.

I checked online and found this from a US study - “As the best combination therapy is unknown, both azathioprine (AZA) and methotrexate (MTX) are used. Some retrospective studies suggest a higher effectiveness of AZA. MTX may have an advantage in terms of safety”. 10 Sept 2021

You could still check though to put your mind at rest. Good luck and hope the combination works for you.

[cakerbaker in reply to LuluM25]

Thanks that is so helpful. I really am feeling so low now with never having a break in my symptoms. It doesn't help I have long covid either. Worried re the breathlessness but I probably will have to wait and see. Thanks for your help 😀