Sulfasalzine or methotrexate

[Kathyem]

Hi, new here! I have to add a new med,either sulfasalzine or methotrexate, been on plaquenil for 20yrs.It has been really good for me! But, now I have been getting flare ups. I am scared of both! Possible liver damage with both, sun sensitivity, with S, is it a given that you have to be covered up? Or avoid. With M- hair loss, weight gain? Thank you for any advise!

[popsmith1874]

Hi Kathyem I just added Sulfazalasine to my Methetrexate and Benepali because my meds have stopped working, I've been on Sulfazalasine before but was dropped due to starting Methetrexate 3 years ago, we go abroad about 3 times a year and I think if your sensible in the sun and use high factor you will be fine plus when it's really hot then a bit off shade helps also I've not really had any side effects but everyone's different so hopefully you will be fine xxx

[Kathyem in reply to popsmith1874]

Thank you for for your reply! Thats good it's been working for you!

[Nuttyshirlz]

Hi kathyem

I’m also started on methotrexate had few problems at start but I’m fine with it now.being on it 10 months and 7 months ago sulfasalazine was also added I’ve always use a high sun factor as one I’m a red head 🙂and two skin cancer is in our family plus I’ve psoriasis But methotrexate has kept me clear of them so it self is a bonus x

[Kathyem in reply to Nuttyshirlz]

Thank you, it is encouraging to see others are doing well with these drugs.

[Nuttyshirlz in reply to Kathyem]

It’s a trial and error thing you won’t no till you try everyone is different what don’t work for some may work for others and we all want same thing at end of day 🙂

[Kathyem in reply to Nuttyshirlz]

Yes, I am realizing that it is a trial and error!

[nomoreheels]

Hiya Kathy, welcome. Well I've been on MTX 8 years & did try SSZ but had to stop it. Each do have side effects but as you know with being on HCQ so long there's no guarantee you'll have any, in fact I had more problems with HCQ than I ever have on MTX. HCQ was my first DMARD too, but it stopped working after a year, that was when MTX was started.

Yes, MTX can affect the liver but it depends on how healthy it is & other meds you take that are metabolised in the liver, all have an effect. I can't go higher than 17.5mg injections otherwise my liver lets me know but I do take other meds that can also have an effect. Both MTX & SSZ have the ability to cause sun sunsensitivity, I just use a higher sun factor sun cream & cover up if I show any signs of burning. I lived in Spain when I first started MTX & didn't have one problem but did when I returned to the UK!

Hair thinning can happen, it did with me when I first started high MTX & LEF but only my hairdresser & I noticed & it settled quickly, I just had a new cut which saved me needing to style it. Most common side effects can be resolved by trying different doses of folic acid, it's due to MTX being a folate antagonist, it can't distinguish that it only needs to target the cells that cause RD or the good ones we need for our replenishing cells like folate. This is why it affects the hair follicles but often once or body has got used to the med it settles, it's a sort of shock to the system but it then says ok, I get why you're hear so I'll settle down now. Obviously it doesn't always suit everyone, it's no different from other DMARDs in that respect but it's not the most commonly used one, that's because it works, it's just if side effects become problematic & just not tolerable any more.

Forums aren't the best place to question any med because they're generally used by those with problems so it's not a good reflection on how good it can be for so many. If you're concerned about anything you can always discuss it with your Rheumy, he's the one prescribing so will explain why he forms the treatment plans for you.

I hope you make the right decision for you, & that you get your RD controlled once again. 😊

[Kathyem]

Thank You, I didn't have any problems what so ever with plaquenil, could almost forget that I had Ra! That's why I'm kinda freaked, it's ran it's course. Yes, I see her in Apr. and I will be writing down all my concerns and questions.

[JayneN in reply to Kathyem]

Hi Kathyem and welcome . I started MTX 10mg. Injections 6 months ago as couldn't take it in tablet . I have noticed a difference to my RA , yes I've put a little weight on and my hair has thinned but I'd sooner that than pain with the RA. I tried Sulphasalazine but was really ill after 5 days but everyone is different and react differently so it's probably a case if trying to see what is best for you . I was a sun worshipper until 2 yrs ago but I got skin cancer so that along with the MTX means no sun but I went abroad last year and put 50factor on and I was absolutely fine ..... I hope you find the right meds and get well soon .....

[Kathyem in reply to JayneN]

Thank You, from all the replies I think what I need to concern my self with his my health, and that I need to just give it a try!! Thank you all for the advise!

[Diane004]

Hi Kathryn

I started the plaquinal when I had a massive liver spike and had to stop my MTX for a while. Taking both has been fine. MTX did cause hair loss and mouth blisters, I increased my folic acid from one a day to 2 a day for the first five days and then 1 a day. Living in a tropical climate (Queensland, Australia) the sun is a pretty big factor in my day to day living. With direct sun I found it is not so much a visible burn of the skin but feels more like it’s a burn from the inside out. Just make sure you cover up. I have fair skin dark hair and have had melanomas removed in the past. Regardless of your meds stay sun safe.

[Kathyem in reply to Diane004]

Thank you for your input!

[EdieB in reply to Diane004]

Hi Diane. My Rheumatologist spoke about Plaquenil as my next drug option. I’m a bit nervous about it having read all the side effects especially the ones that concerns the eyes. I had quite a bit of trouble with mine and I don’t want any added burden in them. Did you ever have a problem with your eyes. I was on methotrexate but only for 6weeks; 25mg injection once a week. It didn’t seem to do anything as my knees felt like someone was hitting them with a hammer and I had one flare that was so bad I could only describe the pain as “emergency room” pain. I have an ongoing problem with a rash and with the methotrexate it got much worse, daily instead of every once in a while.

I’m off everything right now and had a nerve block in one knee and they drained the other and gave me a steroid shot in that one. I go back to the Dr in May to discuss options and the rash situation

Oh happy days lol

[Kathyem in reply to EdieB]

Hi Edie, plaquenil has been my only med fir tge past 20 yrs, was in remission for a good part of that time! Eyes have been fine, just yearly checks. I had no side effects! Though now, it is losing its effect! I am starting methotrexate injection tonight gor the first time! Yikes, a bit nervous! Good luck with what you decide!

[Diane004 in reply to EdieB]

I have some bad days where my vision is like I am swimming underwater. I haven’t had a major flare since the plaquinel was added about 18 months ago but I can relate to the knee pain, also neck and shoulder. As if the pain isn’t enough you have a rash as well. I hope it all gets sorted for you.

[Lyneal]

Been on Methotrexate injections for 18months now, I take a folic acid tablet everyday except the injection day. Am ok, been on hols to hot countries and also been ok. Have now developed hip bursa so am in a lot of pain, but hay ho there is also something.

[Kathyem in reply to Lyneal]

Thanks for the reply! Glad that this is working for you! Yes, there's always something.