Conflicts with dermatologist vs rheumatologist. PsA and methotrexate

[4201]

Just went for my annual dermatologist check up. Although my psoriasis is a mild case and responding to treatment, she stated that Methotrexate that I am on for my PsA is not recommended. The doctor went into depressing details about what it is doing to my body and freaking me out! She even advised that I find another doctor. Maybe I should get another dermatologist! Anyone had this problem?

[allanah]

On this problem I would call the NRAS helpline. They have specialist consultants they can ask for you. Complicated situation!

[helixhelix]

Oh for heaven’s sake! That sounds totally unprofessional. If a doctor has a big issue with a prescription that another doctor issued for their patient then they should discuss directly with that doctor, and not put the patient in the position of referee.

And the methotrexate is not recommended for what? For psoriasis? For PsA the NICE guidelines are quite clear that MTX is a first line drug. I can’t find them just right now to reassure you, but here’s link to the one of the next steps which makes clear that the patient will be using MTX.

nice.org.uk/guidance/ta543/...

Sure MTX is a strong drugs that carries risks with it. It is not a smartie. But it is completely out of order for a doctor to freak a patient out like that for a TOTALLY STANDARD AND RECOGNISED TREATMENT. If they were concerned they should have asked you whether your rheumatologist had discussed risks with you, and checked what monitoring you were on to make sure these risks are managed as best possible. And suggested that you might want to discuss alternatives with your rheumy.

What kind of dermatologist was she? With what qualifications?

[4201 in reply to helixhelix]

I have been going to her for 23 years so I would think she would have more sense than to attack my rheumatologist. Time to find a new one. Thanks for your advice.

[Pinkypie2018]

I would certainly find another dermatologist. I have PSA and I currently take methotrexate, my father also took it for his, and I'm sure many others out there with PSA also take it. My rheumatologist told me it's normally the first drug they try on patients. Ring your rheumy helpline and I'm sure they will be able to reassure you. Good luck!

[4201 in reply to Pinkypie2018]

Thanks for your input. I am shopping for a new dermatologist today!

[jojom912]

I hated Methotrexate, I was only on it two weeks when I got bronchitis that turned into pneumonia. My Sister in law was given it as her Chemo for breast cancer! Funny thing is I was at my dermatologist today for my eczema and we talked about my auto immune being related to the eczema, she said that Rheumy are having great results Olumiant for RA and a extra result it is also clearing up Eczema, but the Dermatologist cant prescribe yet. She knows my Rheumy and called him for me to try. I am excited to try something new that might help both without being as harsh as DNards. good luck

[helixhelix in reply to jojom912]

Now isn’t that what a good dermatologist should do!

(Biologics Iike Olumiant may not be as “harsh” in terms of likelihood of disagreeable side effects such as nausea, but they are strong drugs too that carry equally severe risks as MTX. Having said that I am really pleased to have transferred on to them!)

[4201 in reply to helixhelix]

The dermatologist praised biologics and said that they should be the gold standard for future treatment and not methotrexate. To add insult to injury, she said I now have Vitiligo, a skin condition that causes you to lose the pigment in your skin. I have it on my back and arms. It was made famous when Michael Jackson suffered from it on his hands and face. She did not give me or suggest any treatment for this condition. I guess I am beyond hopeless. Just kidding. Not giving up.

[helixhelix in reply to 4201]

Your dermatologist is talking out of her derrière as far as treating inflammatory arthritis is concerned. She has overlooked the fact that biologics are usually taken alongside MTX, not instead of it. I hope she knows her own field better, and learns to stick to her subject.

[AgedCrone]

I’d ask the Dermatologist to contact your Rheumatologist....if she refuses, I’d change Dermatologists.

Professionals should take the high ground & not criticise the treatment you have been prescribed....no matter how much they disagree with it.

I hope it all gets settled amicably.

[Hidden]

I wouldn't worry about it. I am taking mtx and have PsA. My father was on mtx for years because of severe psoriasis and he got on well with it.

[Soreknees2016]

I take mtx for PsA and my dermatologist is fully supportive of that - what a strange and unprofessional way for your dermatologist to behave! As others have suggested, perhaps your dermatologist and rheumatologist need to get their heads (banged!?) together to sort this out!

[Ladyinredxx]

Yes I took Methotrexate for over 2 years for my PsA stopped taking it

because made my hair fall out. Now taking hydroxychloroquin for 3

years, find this better does not give me headache or feel very tired

the next day. Mine was prescribed by my rheumatologist at hospital

Where I go for check ups. My psoriasis is mild hydroxy is for arthritis.

Hope this helps. Ladyinredxx

[4201 in reply to Ladyinredxx]

That is my biggest complaint about Methotrexate. I have been on it since March and I get headaches and a foggy brain on it. The rheumatologist says give it more time and those side affects will go away. The good news is this drug in 24 hours had me able to walk, lift my arms and basically live again!! Thanks for your input.

[Tile]

Sounds like your dermatologist has obtained some information on MTX or maybe has or knows of patients who after years of taking MTX have also began experiencing the downsides of this strong drug. Unfortunately, just because a medicine works doesn't mean it's the best medicine to treat with. Lowering immunity means lowered cancer surveillance, etc. Have you been tested for MTHFR 677T? Your Rheumatologist may be able to do this along with a homocysteine test since MTX lowers serum folate and sometimes synthetic folic acid or even food folate cannot be metabolized into methylfolate in certain people. Unmetabolized folic acid or UFA is another good test to have, because if found at unhealthy levels needs further investigation. If a doctor objects to treatment it's good for them to give their opinion even if you disagree. and be thankful for a doctor who at least is concerned enough to speak out, rather than be quiet about it. Don't be afraid to question ANY healthcare worker about their suggestions and do your own research because not all information is given or reported openly is the best for you. Even whistleblowers may fear giving knowledge, information, etc due to repercussions. This site is very useful use it to gain knowledge but you may also receive conflicting suggestions, so you have to keep researching for yourself and not just rely on physicians or patients views.

[4201 in reply to Tile]

Thanks for the info. I meet with my rheumatologist in December to go over the numbers and my blood work. We had discussed Biologics but there are a lot of side effects with them too. I am just taking it one day at a time as PsA is challenging in more ways than imaginable. Have a healthy and happy holiday.