Methotrexate. How low should immune response be?

[cakenomore]

I wonder if anyone could help to answer this question. I will be contacting my GP, but with several of their staff off with covid the lines are busy.

I've been on 20mg metoject pen for 8wks. My most recent bloods came back with several abnormal results. Most being the ones to do with immune response. I know the point of MXT is to lower my immunity to treat the PsA but should it go as far as pushing my results lower than the lowest normal parameters? Like a lot of people I would imagine at the moment, I am suffering from anxiety and having a lot of red abnormals popping up on test results isn't helping.

If anyone else has had this happen I would like to hear from you, just for some peace of mind until I can get hold of a doctor.

Thank you so much x

[Hidden]

Hi,I don't know figures but results should be flagged up and doc should contact you if any concerns.

Anxiety is horrid, take care

[AgedCrone]

I would contact your rheumatology nurse if I were you.... She/he will have more experience with methotrexate than a GP.GPs don’t prescribe Mtx...they just follow the instructions of your rheumatologist.

[cakenomore in reply to AgedCrone]

Thank you for you reply. I will contact Rhmy I think.

[bunnycaramel in reply to AgedCrone]

My GP prescribed my methotrexate. I think it depends on GP and rheumatology unit

[Eiram50 in reply to bunnycaramel]

Mine does too

[AgedCrone in reply to bunnycaramel]

If you are under a Consultant rheumatologist, I think you will find he actually prescribes the dosage of the methotrexate and then under shared care your GP will issue the monthly prescriptions.I think most people agree a good rheumatology nurse will usually know an awful a lot more about Rheumatology treatment and the dosage of Dmards than a GP....unless he has a special interest in the disease.

[helixhelix]

Presume you mean your white blood cell count? If your results are below the normal range by more than a tiny bit this should be flagged up automatically to your medical team but worth raising it just in case its been missed.

Do be aware that if they are only just out of range that may not be considered to be significant. They may just want a repeat test in a couple of weeks.

[cakenomore in reply to helixhelix]

Thank you for your reply. Some of the abnormal results where from something called Tissu transglutaminase igA, igM and serum blood protein levels. I will try and contact Rhmy I think. I think I am concerned because I have 5 different hospital appointments coming up and am worried about going out with a compromised immune system.

[cakenomore in reply to helixhelix]

Thank you for your reply. The abnormal results where for Tissu transglutaminase and serum protein . I will contact Rhmy. I have 5 different hospital appointments coming up and am worried about going out with a compromised immune system.

[helixhelix in reply to cakenomore]

Methotrexate really doesn’t suppress the immune system, just compromises it a bit. And neither of those tests are the critical things for your resistance to infections - white blood cell count is the most important.

Do you know why those tests were ordered? The IgA/IgM is not done routinely. It is used more for suspected celiac.

[cakenomore in reply to helixhelix]

My GP had request a wide range of tests because I'm suffering from severe fatigue which is now really effecting my normal daily routine. The Mxt has reduced the Psa pain a great deal so I am keen to continue with it. If it wasn't for this debilitating tiredness I would be overjoyed with the Mxt treatment.

[Hidden in reply to cakenomore]

Chronic fatigue is one of my biggest issue and MTX (for me and Prednisone) made it super bad. I tried switching up days I took MTX so it did not affect work but I got to the point the fatigue took over. This can also mean you are flaring too. It’s a difficult one to sort. I had severe side effects to 3 drugs and just started bio similar but still get 2-3 days of bad fatigue but early days on this too so perseverance needed.

[cakenomore in reply to Hidden]

Thank you for your reply. I'm hoping if it is the Mxt that the longer I'm on it the less tired I will feel.Like you say perseverance.

[helixhelix in reply to cakenomore]

That’s great that you have a doc that’s keen to find out what’s wrong. It may well be the MTX, but equally it may not! Hope you get an answer and a treatment that works.

[cass24]

I'm not familiar with the tests you've mentioned but my white blood cell and neutrophils (both related to immune response) quite often drop a little bit below normal range, in which case, my GP usually recommends testing again in 2 - 4 weeks (depending on the level of concern).

Just before Christmas both counts were particularly low (and I was starting to worry that I might have to come off Mtx altogether) but 2 weeks later, they were back up in the "normal" range (which hasn't happened for months)!

I've no idea what causes the levels to fluctuate so much but of course that's why we're monitored so closely when we're on Mtx and as long as there isn't a consistent downward trend there shouldn't be (too much) cause for concern.

[cakenomore in reply to cass24]

Thank you for your reply. I will have to check with Rhmy. I'm due to start helping with lambing on the farm I live on. I need a certain amount of confidence that I don't have an increased risk of infections.

[cass24 in reply to cakenomore]

Checking with your rheumy definitely sounds like a plan...

As you're probably aware, being on mtx does put you at a slightly higher risk of infection (regardless of what your bloods are doing) but if that's the only drug you're on then hopefully that risk should be fairly minimal assuming you're still following all the other guidelines as far as covid is concerned.

Good luck with the lambing... I have a friend who is a sheep farmer and I know only too well that it's "all hands on deck" at this time of year (regardless of whether there's a global pandemic or not)!

[Moonart]

Hi, I don’t know about the particular results that you mentioned but when my RA was flaring really badly several of my blood test results were up, down, and all over the place but my GP always put them as ‘normal’. I used to work in a surgery and was told they look at your results as a whole and if the dr was concerned they would recall you for a retest sooner. But I would definitely email your surgery if you can’t get through or like others have said speak to your rheumy nurse.

With regards the fatigue, mtx made mine much much worse (RA can cause fatigue too so it was a double whammy!) I’ve tried a few different tablets (mtx, leflunomide) and have now been on metoject for several months. People on this lovely forum have suggested taking the mtx in the evening and I have to say that it has made quite a difference to my fatigue. I’m tired the evening I take it, and the next day, but it’s certainly a lot better than it was. Anxiety is also a really debilitating problem and hard to cope with especially at the moment, I have it too. But if it’s any help I’ve had a few recent hospital appointments and I have to say I felt very safe. They have a lot of very strict protocols in place to keep both patients and staff protected and safe.

I hope you get some answers to your results to put your mind at ease, and good luck with your hospital appointments.

[cakenomore in reply to Moonart]

Thank you so much for your reply. It is reassuring to know I'm not alone in this. I'm having a hard time coping with not being able to see family. I think that makes any other issues seem more difficult to cope with. Here's hoping for better times!

[Moonart in reply to cakenomore]

Yes it’s really hard when you can’t see family isn’t it? I look forward to the day when I can hug my children! They’re all grown up but I miss them terribly. Everything seems ten times worse at the moment. But we will get there! And no, you’re not alone. Big virtual hugs to you 🤗

[cass24 in reply to Moonart]

My GP has started marking my tests as "Abnormal - as expected"...

Umm... surely that makes them "normal"?

I actually felt quite proud of myself when I managed to get "Satisfactory" this month!

[Flor1rence]

hello I inject methotrexate once a week and find it most successful. I have an auto immune disease and started on tablets initially. I understand you feeling apprehensive about going to appointments but as long as you take necessary precautions you will be fine. just to add very good advice from helixhelix regarding this post. good luck

[cakenomore in reply to Flor1rence]

Thank you for your reply. My white blood cell count is still in the normal range so I feel happier about it.

[Flor1rence]

that's good news. 😊