Subcutaneous methotrexate and stomach pains

[RosieA]

I am a newbie to RA. Diagnosed 7 wks ago. I was put on a 4 wk reducing dose of steroids and 10mg subcutaneous methotrexate upped to 15mgs two weeks ago. Spent two days of the week one of the higher dose with a lot of upper stomach pain, a deep burning sensation, night and day. This week it has been four days. Gaviston has given marginal temporary relief. Have left message with hospital help line. Does this mean methotexate is not for me? Is this common? Not sure at this point which is worse, drugs or RA!!!!!!!!

[nomoreheels]

Hiya Rosie, welcome. I'm sorry you've been diagnosed but good you're already settled on meds relatively early on.

Your symptoms, I’d have been less surprised had you been on MTX tablets, it's not something I’d have expected, or experienced, on injections. You see it goes into the bloodstream not through the tum as tablets do. It's one for your Rheumy team to answer I’m afraid. I've checked my 'bible' on MTX & the one you describe is not a symptom of a side effect, not even at higher doses than we take for RD. What is noted is upper right stomach pain, no burning sensation. Have your drug monitoring bloods been within normal values do you know? You may have been given a result book to hold for when you have your bloods taken, you can check there or on the results sheet if not.

Obviously it's something really concerning you so do call the helpline number again, leave another message asking them to call you. I wouldn’t write off MTX just yet, it could be one of those things or just that the new dose is a tad too high as you didn’t have the symptoms on 10mg. Your team will of course advise, they have your records to refer to but they may suggest reducing the dose or even halting it to see if things settle, you'll just have to see I’m afraid.

Believe me, uncontrolled, unmedicated RD is worse! I've been there. The meds can work wonders, I've had 4 DMARDS, been on MTX since 2009 & would be in a rotten way without it. 😫

[RosieA in reply to nomoreheels]

Thank you so much for your reply. It has helped us (supportive husband and myself) refocus our thoughts. Hopefully, concerns about MTX might be a red herring. Am just recovering from dreadful pain after supper and will need medical help tomorrow as discomfort just bearable now and after 5 days I am exhausted. I am reassured that this might not be the methotrexate but perhaps something else induced by either the steroids or the RA itself maybe. Fingers crossed I can remain on the MTX injections as they are starting to help the joints and fatique.

Not been given blood results booklet. I will explore this.

Thank you once again

[nomoreheels in reply to RosieA]

You're welcome. That you had the pain after supper could be telling. Was it oily or greasy by any chance, even cooked in oil or butter or containing dairy, cheese maybe? Have you experienced a similar pain before starting MTX?

[RosieA in reply to nomoreheels]

It was baked organic salmon with a grain salad. Must admit that once it hit my stomach the pain started, intense but is starting to abate. Have never had this issue before. It is concurrent with higher dose of MTX and stopping steroids, two weeks earlier. Although, upon reflection, it did start with a lunch time meal of a 'Craster' kipper, during this period - has put me off one of my favourite treats!

[nomoreheels in reply to RosieA]

Both are oily fish, whilst good for us they can cause troubles if you have sensitivity or gallbladder (gallstones)/cholesterol issues. You may not even know but it is something to discuss when your Rheumy or Nurse get back to you, or take up with your GP. Balancing the fish with carbs may not have caused such a 'flare up', if this is what it is of course, only my thoughts. Gone off on a tangent from your original question re MTX causing the problem but thought it was worth asking if similar symptoms had been known before food-wise as the area you had the pain could indicate this problem. Maybe just one portion today wouldn’t have had the same effect, two could have just tipped it over, eating two of your faves?! As I say just my thoughts.

[RosieA in reply to nomoreheels]

Quick update. Appears it could be gastritis or gallstones (would be surprised as I don't fit any of the at risk factors) Started omeprezole (sorry probably not spelt correctly) and after 18 hours beginning to feel human. You are right about unmedicated RA as I am already feeling some old familiar aches. It's amazing how quickly we forget pain - one evolutionary plus. So oddly looking forward to taking my MTX again once the hospital give the all clear. Many thanks again to all those who replied.

[nomoreheels in reply to RosieA]

Thanks for the update Rosie. The omeprazole should help ease both, whichever it may be, but I’d also help yourself by eating low fat, non oily or spicy foods, that will included limiting or reducing portion size or avoiding oily fish... salmon, mackerel, trout, tuna, swordfish & such. Just have a look online for recommended diet for gallstones (cholelithiasis), that will help should it be gastritis as well. I'm pleased the omeprazole is helping, that sort of tum pain can be very wearing. I take 20mg twice daily & it helps me. We see here often the question do I really need to take this MTX, you're finding out the hard way like I did! It's not such a bad med after all is it?! 😉

[RosieA in reply to nomoreheels]

Thanks. Have been saint like in adherring to mediteranian style diet (- the meat) for nearly 30 years and because of some food intolerances have to make nearly all food from scratch. Hospital (have been ace) say need to get definitive diagnosis before I can resume MTX, and that I need to 'challenge' myself with an 'fatty' meal. Here comes the machrel I fear- dreading it now!! However, it will be good to get it sorted out as the old familiar discomfort on getting out of bed has resurfaced. Ain't it great!! Still, off through the puddles to village hall to vote will add to the joys of the day - then off to machrel battle. Many thanks for taking the time to respond and to share your knowledge.

[nomoreheels in reply to RosieA]

Mackerel should prove the point! It's a pain we need to do these things to prove definitively if we have such sensitivities to food, or allergies. I had to do it with red shellfish (which I love) so we knew for sure I was intolerant, the result is doubly explosive shall we say! It surprises me that it has to be written as an allergy for any medical procedures. I (& my h) eat a mainly Mediterranean diet, just really continuing how we ate when we lived there. We do include some meat though, for it to be balanced we need to plus there are necessary proteins, nutrients etc not easily found otherwise. Lidi do a lovely low GI multi seed cob (h is diabetic), lovely with mackerel or homemade pate. Anyway, rambled on, I hope it proves conclusively then you know what you're about re your diet & can adjust it so you no longer have the pain.

[RosieA in reply to nomoreheels]

Finally! Looks like the steriods have been the guilty party!! Omeprazole is really doing the job, so thankfully able to restart MTX next week, at smaller dose and build it up. Can't wait to put RA symptoms back in their place, so that pups and I can enjoy strolling through the fields again. I wonder how many people with RA struggle with some food groups as I have read so much about GI involvement. Kindest

[nomoreheels in reply to RosieA]

Aha! I wonder how they came to that decision though? Either way it's good your MTX will be restarted at a lower dose, I’d have hoped for that had it been me. Mine has in the last fortnight been reduced to confirm or otherwise symptoms I've been having are MTX or not. Good the omeprazole is helping too.

Food intolerances (inflammation-wise) is something we've discussed here plenty of times. I don't have any thankfully but many react negatively to sugar, the nightshade veg family etc.

Pups?! What do you have?

[RosieA in reply to nomoreheels]

A lovely, rather lively cockapoo. She drags me out each morning which although at times is an effort. I do feel so much better after and invariably some of her antics will make me smile.

[nomoreheels in reply to RosieA]

Aw, lovely. We have two dogs, a Pointer/Lab cross & a Podenco. They do make you do things you otherwise choose not to at times. Those eyes, & how do they know which is their pretty face when wanting something??!!

[helixhelix]

If Gaviscon gives some relief then perhaps the MTX has triggered reflux? It sounds like a minor irritant, but can actually be horrifically uncomfortable and painful. At times I’ve worried I was having a heart attack.

I also inject MTX, and although it affects my stomach far, far less than the tablets I still can feel slightly acid’y afterwards. Talk to your GP to see if they think you could have reflux. You can also get omeprazole over the counter, which is more effective than gaviscon.

[RosieA in reply to helixhelix]

Thank you. Will be seeking help. Although not suffered from reflux, the burning is intense and as you imply could be that the stomach is highly irritated and just needs some protection. Let's hope, as you say, it is minor and I can carry on RA treatment. It's all a new world and can't wait to have things other than RA at the uppermost of my thoughts.

[charisma]

Welcome, Rosie! It’s good you have an advice line; I hope you get a callback quickly. Symptoms ie side effects from MTX do tend to wear off or reduce, given time. I found it also helps to eat stodge eg pizza on MTX day, and take the folic acid as prescribed. Best of luck!

[RosieA in reply to charisma]

Oh Thank you. Yes people on here have been very supportive. It's the first time I have used such a 'service' and have found it helpful to have ideas critalized or to be reassured.

Have chatted with hospital and they doubt MTX is the guilty party. Off to Drs soon to have examination, if no luck there, then the hospital will check me over. Must say, great service from my hospital, the specialist nurses have been so very knowledgeable and at no point do they make you feel that you are wasting their time. Just need to get on top of this blip so that I can resume my treatment. All is on hold at the moment.

[charisma in reply to RosieA]

Yes, ‘blips’ can be easily thought to be part of RA or its treatment. Tricky at times. 🙂

[AgedCrone in reply to RosieA]

Are you drinking plenty.....with Mtx you need to keep really well hydrated....even on the injections.

I always thought I drank enough...but I doubled my intake on Mtx. ..& did really well on it for years.

[RosieA in reply to AgedCrone]

Yes, thank you. Luckily I always appear to have a cup of tea / water in my hand. You are right about how much you need. Even though I drink a lot I still found that I was very 'dry' when I first started MTX.

GP /Hospital now checking liver, gallbadder and gastritis as cause. Who'd have thought it could all become so complicated!! Now off to find some comfort in the marmalade jar - always makes me feel a little better.

[AgedCrone in reply to RosieA]

You have the right idea...you are in charge ..NOT the RA!

It can be a bumpy ride..but with patience you will get your life back on track.

Hope the innards settle soon!

[ketiv74]

Rosie, I had similar issue right after I began treatment, which was tapering dose of steroids and 15 mg Mtx inj once a week. I started having burning pain in chest/ stomach about 3 weeks after I started taking meds, As you said the culprit was the steroids. Dr prescribed Omeprazol. I found another way out though I think it was one of this forum or somewhere online, don't remember now. So all I did was put my steroid pill in one of the gel caps I was taking for turmeric. It delivered the pill into the digestive track once it got past the stomach, saving the stomach lining from erosion from steroid. After 3/ 4 days of doing this I saw the difference. Drinking alkaline water also helps in general , not only with heart burn/ acid reflux but in general with pain too. Hope this helps.

[RosieA in reply to ketiv74]

A good tip thank you. I'm hoping that the worst is over. Interesting that you had the same experience. Upon reflection, perhaps taking the omeprazole alongside the steroids might have avoided this. Ho hum - live and learn. Alkaline water? Please enlighten. Kindest

[Jaxine]

Hi there. I was first put on MTXas my first smart however, within in a few weeks I developed a severe chest infection so MTX was mmediately stopped, apparently very rare effecting only 2%. Since Jan I've tried other Dmards and 3 biologics. I was diagnosed Jan this year. Chin up you will eventually find the right meds. I've had great support since diagnosis from all the lovely people on this forum.

[Davibrew]

I was diagnosed with psoriatic arthritis a year ago and spent the last 12 months trying alternative approaches (diet, CBD, etc.) but as things got worse I gave in and started taking methotrexate 3 weeks ago. I too take it subcutaneously and today was my fourth shot. I have yet to feel the benefits other than my skin is clearing up a bit. The first week I had mild gas but progressively my GI symptoms have worsened with cramps, bloating, and diarrhea, especially after eating a meal. Mornings are worse. I take folic acid daily as well.

[RosieA in reply to Davibrew]

So sorry to hear you are struggling. My stomach issues ended up being the steroids. I now need to take PPI daily. I am also no longer on MTX as my symptoms are more suggestive on UCTD and I now take Hydroxychloroquine. Do speak to someone as they may be able to protect your tummy. x