Advice about methotrexate injections

I was diagnosed With seropositive RA just over a year ago and am currently on 17.5mg methotrexate per week, plus folic acid 6 days a week and 400mg Hydroxychloroquine per day.

I had my scheduled rheum consultant appointment today and was really taken aback when she suggested I might prefer to change to methotrexate injections instead of the oral version I am taking atm.

Last appointment we had agreed that I would drop my oral dose from 20mg back to 17.5mg as I was suffering side effects from the inc dose. No side effects on 17.5mg.

Today she asked if I had had any flares recently and I told her all I had had was pain in one or two joints for 24 hours at a time which then remained swollen and a bit stiff for a few days. This happens about once a month.

I asked about my inflammation levels which she agreed were 'borderline' - CRP mostly below 5.

She said there was no hurry to change but will inform the rheum nurse so that I can contact her at any time to be 'trained'.

I don't have any real problems with transferring to injections and can see that I would have to if my dose needed to be increased. Just not sure if it is necessary. Or will I inevitably need a higher dose eventually?

Would be very grateful for any advice or comments from others who have experienced similar please?

12 Replies

  • Usually with injections we can take a step down in dose of MTX than in tablet form. This is because as it doesn't go through the digestive system it's more effective, it goes straight into the bloodstream. The training is to demonstrate how to use the pen & they usually want to oversee your first. I was changed from prefilled syringes to pens without being informed so didn't have training & I had no problems doing it myself without being shown.

    It's quite normal for doses to be increased, or decreased. I've been on 15, 17.5 & 20mg at one time or another, currently 17.5mg, I can't have another increase as my liver objects.

    Most who go on to injections remain on them, more so than tablets as a rule. I find them far easier than taking those little yellow pills in one day, a quick click & you're done for the week. I hope they suit you when you start on them.

  • I have been on pen injections for three months now without any problems. The nurse will show you how until you are ready to do them yourself.

  • i was on Mtx tablets previously and much prefer the injection. It's really easy to administer and I've had far fewer side effects. They're much more expensive than the tablets, so if you're being offered them I'd say go for it! Good luck.

  • Hope the transition goes smoothly.

    I am on MTX, have been for several years and when I went onto injections had less side effects... as previously mention, you need less of it so good all round.

    The pens type injections are a no brainer... remove cap; press into top of thigh and press button; once the yellow fluid (MTX) has gone, count to ten and lift pen.

    If your issued conventional, old type injections you'll get training too.

  • I've been on the injection for 2 months and it's works so much better than the tablets. The injection is easy to do & it gets in your system so much quicker. It's worked really well for me.

  • I am on 20mg of pre filled syringes and find it so much better than the pills. I can't say about the pens as I have never used them.

  • Hi your case sounds like a carbon copy to mine i went on injections a year ago and since going on them the side affects have significantly reduced the injections are really easy to administer based on my experience i would strongly suggest you try them you can always revert if your not happy with them.

    Good luck hope everything works out for you

  • Many thanks for all your replies - I think I'm definitely coming round to the idea.

  • Hi Bookworm55.

    I think your rheumatology consultant is thinking of you in having less side effects by having injections, injections it by passes the digestive system which means less side effects. You shouldn't need a higher amount if your ok on the dosage you are presently taking or unless your blood levels go up.

    I went straight on Methotrexate injections 10mls for the same reason having less side effects, talks about increasing has CRP levels are still high at present. Was diagnosed with Seropositive last October. I'm also taking folic 6 days a week, 200mg Celecoxid twice daily also Hydroxchloroquine.

    Admittedly I am needle phobic needed to go hospital every week to be trained by a rheumatology nurse for many weeks. For the last 3 weeks I am now injecting myself but don't look forward to Friday's as i still find it hard and takes a while.

    I hope this helps.

    I wish you well x

  • Thank you.

  • With injections you know you are getting the dose prescribed, with pill form there is really no telling how much of the medicine is being absorbed by the stomic etc. So at least with injections you know your getting it. Methotrexate stopped working for me in the pill form years back, we switched to injections and success right away.



  • Thank you.

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