Methotrexate for Crohn's related arthritis

[OctoberOrchid]

Hi,

I know this is the RA forum, but I hope you don't mind my posting here since the majority of people with Crohn's don't deal with inflammatory arthritis.

I'm currently on Entyvio which is gut specific and has my GI symptoms in check, but my extra-intestinal symptoms are flaring including arthritis and iritis. I've been on Imuran with Enytvio, but that hasn't gotten rid of my flare, so my rheumatologist added Methotrexate. I've been on it for 9 weeks now and have not yet seen any benefit. Does this mean I will most likely not respond to it? I did start out on a low dose at first, 7.5 mg and have just worked up to 15 mg in the last 2 weeks.

How long do I need to wait to see any benefit? And is this supposed to completely get rid of all my inflammation? When I was on Remicade and Humira in the past, my gut symptoms flared but they kept my arthritis completely at bay. Is that how Methotrexate is supposed to work as well with no arthritis inflammation?

[oldtimer]

A tough one. Remember we can't give any medical advice, but for Rheumatoid Disease 15mg methotrexate is not a high dose and you have only been on that for a couple of weeks, not long enough to know if it will be enough. It's probably worth continuing with it for at least six weeks - although they may have in mind for you to continue increasing the dose?

[OctoberOrchid]

Thanks for your response, Oldtimer. Eventually I think the goal is 25 mg, that or 20, but I want to push for 25 mg since I've read that you need higher doses to get iritis/ueveitis under control. I think the reason my doctor is being so slow in upping the dose is that I'm also on Imuran, which I hope to stay on since I eventually would like to transition back to that. (I was on Entyvio with just Imuran for 3 years and had no real issues with arthritis.) I'm getting a bit impatient and wish I could just take the 20 mg or 25 mg right away but she's monitoring blood work and upping my dose every 2 weeks by a 2.5 mg pill.

Are you on MTX, and if so, do you remember how long it took to see improvement?

Also, does MTX help gradually or is it a fairly noticeable improvement once it kicks in?

[AgedCrone]

I don't have Crohn's so have no knowledge of how long Mtx takes to kick in with that additional condition, But Mtx at say 20 MG per week for RA can take up to at least 3 months to have any effect......& sometimes longer.

The other drugs you are taking may affect the time scale too.

Have you got Rheumy nurses you can speak to.....they would probably have experience of your situation? Maybe the injectable form could suit you?

Presumably your rheumatologist thinks Mtx is a possible or he wouldn't have prescribed it.

Unfortunately a drug that helps me in three months, might take longer to help you...so hanging on in there.....Hope you get a good outcome soon.

[OctoberOrchid in reply to AgedCrone]

Thanks, AgedCrone. It's nice to know dosages and time lines. My Rheumy said for other rheumatological diseases like RA it can take up to 6 months to have effectiveness, but she didn't specifically say anything for my Crohn's-related arthritis. She did say it's too soon to know if it will work. I'm just getting impatient. Now I'm really wishing I were already at the 20 mg if it can take at least 3 months at that does to have any effect, sigh...

I was actually on the injectable form when I was first diagnosed with Crohn's in conjunction with Remicade, but that was solely for prevention of antibodies to Remicade. I was asked if I wanted to do the injectable form or pills, and I said it didn't matter to me, so she just prescribed the pills. I suppose if the pills don't seem to be that effective some people switch to the injectable form and that works better, so maybe that's another option.

Thank you for your encouragement! I really need it right now.