Methotrexate dose

[Grubbypaws]

Good morning! I've been taking methotrexate since mid September. I was on 15mg a week but then had to take a break for 7 weeks because I had surgery. I went back on 10mg weekly from mid January (increased to 12.5mg last week because I complained about pain) but I don't feel any different! I'm also taking 7.5mg prednisolone daily (increased dose from 5mg last week) but I'd been hoping the mtx would stop the need for the pred. My question is, how long does it usually take before you notice an improvement with mtx?

[helixhelix]

Was it working before you stopped for surgery? If so, then probably not until you’ve got back to 15mg for a few weeks. Sorry!

When MTX was my main drug 10mg would do not much more than a sugar pill...I had to get to 17.5mg before it started working. We are all different, so maybe 12.5mg will do it for you, but generally needs 12 weeks to become effective.

[Grubbypaws in reply to helixhelix]

Thanks helixhelix. I didn't think it was working at 15mg either - most of the relief seems to come from the pred (as soon as I try to taper off that I really feel the pain). Guess I'll just persevere for another couple of months.

[Dobcross1]

Hi there MTX took 14 weeks to start to work for me at 15mg - I spent far too long on that dose (4 months) before increasing to 17.5mg. Again stayed on that for too long until I saw new Rheumatologist after Christmas who increased my dose every 4 weeks till I reach max 25mg next week. So the moral of the story for me is I should have pressed for a dose increase instead of putting up with symptoms.

[Grubbypaws in reply to Dobcross1]

Interesting. I will push for that next visit, thank you.

[charisma]

Hi Grubbypaws

A short break of a week or two would not make much difference but it seems that you really need a much higher dose, considering the need for corticosteroid too.

Maybe it would help to call your RA helpline and explain how much pain you are experiencing?

You might need a change of DMARD if MTX is failing you.

[Boxerlady]

I started on 15mg at the end of May last year and increased to 20mg at the beginning of August. As I've still got some joint inflammation they're changing me over to injections - still 20mg but have said that will be increased if it doesn't have the desired effect. I had a break of a week because of a virus but felt no reaction. However I've really struggled with the current break of 4 weeks (delay in getting appointments for injection) so I've needed a steroid injection to tide me over. I'd consider pushing for a higher dose - that's what I've done this time and my team has been very receptive.

[Grubbypaws in reply to Boxerlady]

Good to hear that you felt the difference during the 4 week break (although not for the pain of course), at least you know it's working. I guess I will only discover if the mtx is working once I stop the pred and then work out if I need a higher dose from there.

[Boxerlady in reply to Grubbypaws]

Must admit that's exactly what I thought - my joints have been much worse than when I was first diagnosed (I was lucky as I was fast tracked and started treatment very quickly) so it's really proved to me how effective my medication is.

[Grubbypaws]

The break was 7 weeks so quite a gap. It's only been 11 weeks since I went back on it. I'm not in pain now so will see how it goes when I go down to 5mg pred at end of March and will talk to my rheumy about upping the mtx on my next visit at the end of April.