Methotrexate

[Beachgirl62]

Hello I’m new to the group I have been taking methotrexate from October started on the 15 mg now up to 20 mg but doesn’t seem to be making any difference how long does it usually take before it stats to work I’ve read that it doesn’t work for some people has any body found this

[MadBunny]

Are you on mtx only? I was put on sulfasalazine first, which took about 4wks to start working , them mtx was added later. Maybe it might be worth giving the rheum nurse a ring?

[helixhelix]

The average wait for it to start working is 12 weeks at a therapeutic dose (ie above 10mg). With some people it takes longer. For me MTX alone wasn’t enough by itself and I went on to triple therapy of MTX plus sulphasalazine plus hydroxychloroquine.

Have your blood test results shown any improvement?

But talk to your rheumy team and see what they suggest.

[Flipper12345yellow in reply to helixhelix]

Hi,I was the same, ring nurse they may add in something else.

[Boxerlady]

It might be that you need a higher dose and/or another medication added. I'm now on 25mg Methotrexate by injection and Hydroxychloroquine (maximum dose of both) and Sulfasalazine (so triple therapy.) I didn't wait the full 12 weeks of each increase/addition before contacting my team and they were happy with that; letting them know the situation won't do any harm and you don't want to wait too long and then have them say that you should have contacted them sooner.

[Gnarli]

It was between 12 and 14 weeks when I started to notice small improvements. It was a long process with failed additions of sulpha and hydroxy and I'm still on just mtx four years later which suits me very well.

[Kentishman]

It took about 3 months for methotrexate to start working for me. Co-incidentally, it took about six to nine months for the side effects to reduce, e.g. nausea and extreme fatigue. Had to come off methotrexate for a two periods of 3 - 4 months and it took about six to eight weeks for it to clear out my system and the symptoms to start to reappear. Hope this helps.

[Niao]

I have only been on Methotrexate 15mg for almost 9 weeks now, and had to stop for a week, along with Prednisolone, and now have just started Hydroxychloroquine too. I have yet to see any improvements other than the initial remarkable effect of the steroid.I was aware it could take, in many cases, up to 3months or more to start working so am not overly worried as yet.

I would too, as others have said, contact your Rheumatologist and see if there is something they could add to the mix. It could well be that Methotrexate might not be the one for you, or me, but I hope it is a case of just upping the dose or adding something in.

I really hope that you find some improvements soon, it's not easy is it! All the very best. Xxx

[stbernhard]

We all react differently, but 12 to 15 weeks should show some results. Please speak to your care team for advice. Good luck.

[Hidden]

I was diagnosed with what they think is psoriatic arthritis with spinal involvement last Jan and saw no improvement at all after 11 weeks at 15mg and a further 6 weeks at 20mg. It was only when they added in Leflunomide that anything changed and I was finally able to taper down and get off the steroids. Then found I had side effects with the leflunomide that made us reluctant to increase the dose of that, so put me up to 25mg mtx injections in July with little to no effect. Had a telephone review just before Christmas, where a different consultant put my lef up by 5mg a day, and at this point have finally seen some further improvement, but still not where I want to be and struggling with skin side effects from the increase. I maintain that mtx doesn’t do much at all in my case, but the consultants are adamant I stay on it, in part because my arthritis still isn’t controlled, but I don’t meet the local criteria to try biologics as although I have symptoms in my hips and lower back (that we know are arthritis from MRI), I ‘only’ have one visibly swollen joint. If this lef increase hasn’t worked in 9 weeks’ time, they’ll add in sulphasalazine. In your shoes, I’d be asking them what to add in or switch to, but you’ll probably find that they want you to persist longer with the dose increase before agreeing to do anything different.

[FAISAL2020 in reply to Hidden]

Hi Charlie, sorry to hear that you were diagnosed with psoriatic arthritis... I have been diagnosed with psoriatic arthritis last month. You mentioned to have one visible joint. I have had 5 episodes of swollen joints in a period of 6 weeks 1 in my right knee and 4 in my left knee and now they do not want to aspirate it as they think there is no point to do it as it comes back everytime they do. Is your joint still swollen and can you bend your knee ?Many thanks

[Hidden in reply to FAISAL2020]

I currently have one visibly swollen joint (finally starting to go down after 16 months flaring and a year of treatment), but 9 involved joints total plus my lower back having been undiagnosed and untreated for the better part of 20 years. I’ve previously had a prolonged flare in my left knee, and as with any joint that I’ve experienced swelling in, when swollen they don’t bend properly as the inflammation restricts range of movement. Obviously, I’m not remotely medically qualified, but my understanding would be that aspirating the joint serves two potential purposes. The first is diagnostic, so establishing the cause of the swelling, the second is if the swelling is really severe to try and ease the symptoms, but ultimately, if you have an inflammatory arthritis like PsA, what they need to be doing is getting you on effective treatment (which quite often can and does take months to start working) with steroids as a bridging treatment in the interim. Steroids will bring the swelling down in the short term and improve symptoms in your knee.

[FAISAL2020 in reply to Hidden]

Thank you Charlie for the quick reply... yes my rheumatologist prescribed me methotrexate and a steroid injection. I took the first dose of Mtx and then two days after that I have tested positive for COVID and I was advised to stop the mtx for 4 weeks. I have one week to go to be back again on the meds. And I really can’t wait for the meds to work and the swelling to go down as I have not been able to bend my left knee for 3 months now.

[Adnil53]

I would give it a bit longer , my consultant said 4/6 months . There is something that you can have with it but you are on a low dose at the minute , I usually take 25mg . Hope this is helpful

[Beachgirl62]

Thank you all so so much for replying this has helped me so much. I have contacted my RA Nurse and waiting for a reply I am in so much pain and finding it difficult to walk

[Adnil53 in reply to Beachgirl62]

Maybe you would benefit from the Kenelog injection ! It takes a couple of days to work and last about 4/5 months

[MoniqueB]

As others have remarked, sometimes the Methotrexate takes a little while to kick in. In my case, I started to notice a significant difference in about 4-5 months (but even with the improvement, my Rheumy eventually added a biologic). Prior to that, I couldn't walk for longer than ten to fifteen minutes and some days I couldn't walk at all. Also, during the first few months of starting Methotrexate, I had to take Naproxen to combat the discomfort of RA. I still use it when I'm having a flare. Do you have any Naproxen at hand? I find that it really helps take the edge off of the pain. I hope you feel better soon. Hang in there.

[Beachgirl62 in reply to MoniqueB]

Thanks for the reply yes I have been taking Naproxen and take pain killers I was in hospital for 14 days and had steroids by drip then the injection and then I was on the steroid tablets but as soon as I start to reduce down its all starts again really appreciate all the info

[Dianemikey4948]

Hi, When i started taking Methotrexate it was three months before i felt any improvement, good luck. Xx

[Rashford20]

I noticed little improvements then after around the 6/7 month mark I improved massively (dose was also up to 25mg for around 2 months at that stage).

[Beachgirl62 in reply to Rashford20]

Thanks for the reply will give it a bit longer hopefully things will get better