I have had a chest infection since Boxing Day and as we all know, when you get a bad virus or infection it’s better to come off your methotrexate so your body can fight it.
My doctor, yesterday, called it a juggling act. Being on RA medication lowers your immune system. When your immune system is low, you’re more prone to bugs. When you catch something, your body needs all it’s fighting components and the best way to do that is temporarily stop your RA drugs. Which is usually fine for a week or so.
But here is where it gets difficult. It’s now been 10 days. My infection is still there, rattling away in my lungs. In order for me to get better, i will have to miss my second methotrexate injection, which then makes me more vulnerable to getting a flare. If I take the methotrexate my body probably won’t fight the infection.
Ughhhhhhh.
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Jules13
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That’s really the tricky part and frustrating too. You can’t help but feel anxious as the worry of a flare. I try to eat as many of the anti inflammatory fruit and veg stuff (loving kiwis and pomegranates at the moment high in vit c). However, caught a virus and am now like you trying to get better, due to the coughing and vomiting yesterday my ribs ache, it’s horrid.
Rest up and I hope you are feeling better soon Jules, we have no choice in the scheme of it all. Take care - Hessie
Opinions differ, but personally I think your doctor is right stopping your mtx and give priority dealing with your infection first. You should be ok for at least a couple of weeks as it can take some time for the positive effects of mtx to wear off.
Methotrexate builds up in your system and it takes a while for it to wear off. I had to stop it for 4 weeks when I had a severe tooth infection with an extended period on antibiotics and it had far less effect on my RA than I had expected.
Ok I’m feeling that maybe my GP is doing something wrong. I’ve never been told to stop methotrexate when I’ve had an infection, the GP just checks which antibiotic is ok to take with methotrexate. I do sometimes have to remind them to check though. Never had any problems.
Not necessarily. This is very individual as it depends on the severity of the infection you have and the liklihood of it going wild, your general health, your age, other medical comditions amd so on. I am overall v healthy, amd the infections I've had have been pretty mundane, so have never needed to stop MTX.
How much methotrexate are you on? I’m on 17.5 plus 2 other RA drugs and had the infection for10 days with a history of asthma so they’re being very safe. X
I’m only on 10mg as it’s all I could tolerate but I take hydroxy, Pred, voltarol amd benepali too. The asthma would make a difference and as you said, better to be safe with other conditions involved x
In the same boat Jules have had a chest infection for the last month 4 lots off antibiotics and now fighting a cold virus which I’ve had since NewYear, vigorously trying to get rid as I’m going to the Canaries on Wednesday and I’ve stopped my methotrexate in the mean time, I’ve had a few chest infections and nymonia since being on methotrexate 3 years ago also on Humira usually 2 rounds off antibiotics do it but needed 4 rounds this time, hope your better soon xxx
Hydroxy & sulpha are relatively mild meds. Hydroxy has very little effect on the immune system, so is ok to take with an infection. Not familiar with sulpha but that's probably similar with regards to the immune system.
edit...tell you what jules, I wish my GP was as clued up with RD meds as yours seems to be.
My GP is the head of a large medical practice so she should know. A lot of GP's don't though. I tend to always ring my Rheumy nurse as well as my GP... the Rheumy nurse can't physically see you but with their knowledge combined with my GP's, I trust what they say to do. x
I'm glad Aged Crone said that 'most' doctors know which antibiotics can be taken alongside mtx as mine was certainly not one of them when he prescribed one of the two antibiotics that should not be taken with mtx...trimorptherin (scuse spelling) I think it was. My local pharmacist picked up on it a couple of days later and asked my wife to tell me to stop taking it. I can't remember why it conflicts with mtx but don't think it's dangerous as such, perhaps more to do with it stopping mtx working or something like that. I never see my GP if it's RA related.
I was told by my biologics nurse and my GPs that you must never take Trimethoprim if you are taking Mtx. My nurse said it could cause nephrotoxicity. I have seen that before on the NICE Guidelines too. I have been given Doxycycline for chest infections.
I thought my pharmacist said something about trimethorprim stopping the methotrexate working or vice versa, but I may well be wrong as it was a few years ago. Guess I was fortunate that it did not affect my kidneys. Goes to show how vigilant we need to be.
I'm glad you found out before you took many. Maybe some of us wouldn't be affected by this combo of meds but it's scary to think that a GP may not be aware of all you are taking and reactions between meds. I believe our practice GPS use some software that indicates meds that can't be taken together.
I've seen my GPs checking in a book, which doesn't seem to have happened in this case. It took place a few years back when I was naive enough to believe that my GP would have checked first.
I check with my village pharmacist as he's a friendly sort and seems more knowledgeable than my GP regarding meds. That said, whoever we ask, providing their eyesight is good and they check in either a book or a computer screen then all should be fine....I hope!
I think it's always best to remind them. They used to look on MIMS online or the paper version. Now it seems to give them the info needed on my "home page" as such.
Your doctor is correct Jules.....athrough on the whole GP's aren't very clued up on RA drugs, Mtx has been around for so long most doctors do know which antibiotics can be taken alongside it, but they can also judge the priority of getting an acute infection like you obviously have under control.
Hi Jules, I’ve also had a chest infection for around 10 days and I’m only just starting to feel better. I’ve had differing opinions on what to do about methotrexate. I have gone with my rheum nurse opinion as I trust her judgement. She was me it’s a judgement call, so a nasty cold, you might continue with your weekly dose but I’ve had a chest infection and been on antibiotics, so I was told to skip a dose. Take it easy, there are a lot of germs going around at the moment. Look after yourself x
Ask for a sputum test as not all antibiotics work on all bugs. I have a lung condition and a rescue pack of antibiotics in my cupboard and see a consultant too. Doxycycline is my one of choice and works quickly too. But I'm allergic to Penecillin anyway. I've also had lessons in coughing and you could look up circular breathing techniques and coughing. They do work to clear the mucus well. And also I was advised lots of fluid as the lungs dry out first hence lungs are vulnerable too bugs. It does appear to be true and water costs little. I don't know about MTX but LEF it was carry on as normal, but it works for so long the odd missed dose would not have been noticeable I supose. x
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