Methotrexate not working?: Hello and happy new year! I... - NRAS


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Methotrexate not working?


Hello and happy new year!

I was diagnosed in August and started 25mg mtx in Sept. Before the holidays I had started to feel a little better, less pain and more energy. Then had a series of coughs and colds followed by strep throat and was feeling rubbish again. Over xmas have been flaring worse than ever and now is very painful in my knees which is a new one for me, and making it very difficult to get around.

My question is how long before you saw a real difference from the mtx and if there is no improvement how long before you tried something else. My rheumatoid did say that when she sees me next in Feb she would add something else to the mtx if I wasn't feeling better, but not sure what!

7 Replies

Hello it could take a few months before you notice a difference ,but everybody's different I started off on sulfazalasine then after a few months they added 20 mgs of methotrexate ,then upped it to 25mgs which was to high for me so lowered it back down to 20mgs and added hydroxocoloquine which is what I'm on at the moment so it's just trying to get the right combination

It took 3-4 month before o felt any easier but it still wasn't enough for me so they added another disease modifying drug then. February probably feels ages away but yes it will give mtx the just about right amount of time to see if it helps. Do you get pain relief right tho, if your still sore I found GP 's are the best for that advice xxx

Hi Sam,

The MTX takes about 12 weeks to get up to speed so still be gentle with yourself and the physical demands you make of your body. I work full time teaching so my weekends no longer consist of cycling all around the country but now more off a gentle walk, the odd coffee shop visit, being at home sketching or something so that I don't get fatigued and cause a flare. I'm lucky in that I don't have a young family to fit in - how parents deal with that one and a RA flare beats me - they have my full respect!

I hope things get better for you soon

All the best


Generally the docs like you to stick with MTX for 6 months before deciding that it isn't enough on its own, or it has failed you. It often takes 3 months for it to start working, but a further 3 for it to really get things under control. For me it did quite a bit, but not enough so I eventually ended up on 3 drugs - and some 18months/2 years after diagnosis things were hugely improved. As was my ability to be a patient patient!

The classic pattern is MTX first, then hydroxy, then Sulpha. Or a switch to Lefluomide. And if that then fails and you still have high disease activity biologics might be offered. But for biologics one of th criteria is that you have tried MTX for at least 6 months (or didn't tolerate it) - so February will get you there.

sambc in reply to helixhelix

Thanks...Hopefully I will see some improvement by then or with adding another drug in combination. Biologics won't be an option for me in Canada as we are self employed and could no way afford them, so I am praying something else works!!!

helixhelix in reply to sambc

Well I'm on the triple MTX, Sulpha, Hydroxy combination and am in remission. I've read a lot which the traditional (cheap) drugs can be as effective as biologics for the majority of people - so good chance you'll be one of them.

Hi, I've been on MTX for 15 months now along with Sulfasazine and I still have my doubts that they are working - I'm finally getting over an 5 month extreme flare of hands, knees, ankles, feet & wrists but they still say I have to stay on MTX although have had tests for going biological... Passed the 1st but failed2+3 due to improvements.. Hospital say it's because my body has adjusted to it ok so I should stay on it??? I'm sick of taking so many pills! Good luck!

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