Mtx and its effectiveness

[sconnor10]

Me

Im in my 6th or 7th week of mtx. They game my Bacfloen and some other anti-inflammatory with it.

My Q : How long does anyone typically go before any real remission of any kind begins ? I just sort of relapsed the other day near my right hip which showed up on xray as being vulnerable to fracture 10 - 20% in 10yrs. Then all my joints were really hurting all at once. So my Osteoposrois or Osteopenia areas are affected by the RA, i think ? If not does the Mtx really help then ?

[Tinkerbell5]

It’s taken just short of a year on mtx to feel a bit of relief

[sconnor10 in reply to Tinkerbell5]

Did you have any issues with liver tests and i guess kidney function since starting. I heard some do. What dosage have you been taking. thanks for reply !

[BoneyC]

It's early days and RA waxes and wanes, some people never go into remission. MTX helps to suppress the immune response to slow down the progression of the disease. There's no way of knowing how well it will do this. As an example, I've taken MTX orally and now injectable for over 30 years, it's been the best drug for me, but has not put me into remission and I have lots of joint destruction. It's impossible to know what the outcome might have been had there been biologics available in 1971.

[nomoreheels]

Hiya sconnor10. You may start to notice some improvements in the coming weeks with your MTX but generally, as with all DMARDs I'm afraid, it's given as 12 weeks or so before it reaches it's full effectiveness. The NSAIDs are intended to ease any pain or inflammation in this waiting time but if they still aren't then maybe seeing your GP would be helpful, he may offer you alternatives or even a short course of steroids. When I was first diagnosed I was prescribed a DMARD (hydroxychloroquine), 2 NSAIDs (celecoxib & nabumetone) & oral steroid, the NSAIDs & steroids worked quickly & I had relief until the HCQ kicked in.

Remission is the dream & what we all aim for. Some are fortunate & find it early on if the right treatment is found but Rheumatology isn't an exact science, it can depend on so many different things... how soon after first symptoms appear you're diagnosed, how extensively your joints are affected at diagnosis & if you have any erosions on diagnosis, how mild or aggressive the disease is & your response to the treatment. There's no one med fits all I'm afraid either so it can take trying a few different ones before the thought of becoming controlled can be considered. Some find remission on DMARDs, others don't & need to move on to the more expensive anti/TNF's or biologics in an effort to become controlled. Currently there's no cure or guarantees with the meds our Rheumy's have available to them, so it can be trying & require lots of patience I'm afraid. Certainly doing all you can to help yourself with a good balanced diet & a personalised exercise plan helps, you can ask your Rheumy for advice.

Could your X-ray have been a DEXA scan? This measures your bone density & gives an approximation of your fracture risk percentage over x number of years, it would make sense with your fracture estimation. I have osteopenia/borderline osteoporosis too, whilst you can have either & not have RD the thought is the risk is double if you do have RD. Unfortunately though your MTX (or any other DMARD) isn't effective in treating your bone density/osteopenia or osteoporosis, another class of med called bisphosphonates are, plus supplements of calcium & Vitamin D (Adcal D3). Don't underestimate the benefits of a good diet (I include some dairy) & exercise to help bone density either. I have biennial DEXA scans & the last two have shown both have positively affected my fracture risk scores, even though prior to both I had to stop two different bisphosphonates due to side effects. I don't drink alcohol or smoke either, it's considered both can have an affect on bone density. I'm sure if your Rheumy thinks they're appropriate he/she will discuss prescribing a bisphosphonate &/or calcium & Vitamin D supplement.

I hope some of this helps. It's a big learning curve when newly diagnosed, lots to take in so maybe a look through the NRAS site nras.org.uk & the Arthritis Research UK site arthritisresearchuk.org. Ask here too, we've lots of varied experience between us so there's little we don't know.

[Hidden]

When I was first diagnosed with RA 30 years ago, I was seronegative and went into remission quite quickly (Sulphasalazine) Now I'm seropositive, I'm finding it more difficult to reach remission although I'm on MTX, Leflunomide and Rituximab. I also have Osteoporosis and have annual Zolondrenic Acid infusions. Also have Vasculitis, Osteoarthritis, Sjogren's Syndrome, Bronchiectasis, high blood pressure, and cancer (in remission). Remission speed for RA is different for everyone. RA makes you more likely to have Osteoporosis, but RA won't affect your Osteoporosis. You're no more likely to have any fractures because of the RA.