I know this might seem a silly question to you old experienced lot who take Mtx but I'm wondering how long it takes to start working more or less. I realise we are all different but I'm wondering what to expect
Do you wake up one morning and your pain is a lot less or gone or is it a gradual process.
I'm on 10mgs metoject. Have only had 3 doses and wondering when and if it will work. When do they consider it a failure
I have a nurse telephone consult in March to discuss but I would like to know these things from you lot, the experts.
After how long do they decide to increase the dose.
I know these sound trivial questions but I would really feel encouraged by your experience.
Many thanks.
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Cheylann
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Hi Cheylann, mtx, like other drugs, can take a while to work, up to 12 weeks but you may start to feel some improvements before that. I can’t remember how quickly my dose was upped as it was so long ago but hopefully someone else will be able to answer that for you.
Hi, I felt a definite improvement on the tablets by week 7 then more and more progress with each week. Slow but definite. I was told 12-16 weeks, the average being 12. I hope you feel something soon but be prepared for a bit of a wait. It will be worth it. I had excellent results for many years then switched to sub cut. Good luck. 🙏🏻(PS I’m 62 in years, but not looks or attitude!)
They usually say 12 weeks but hopefully you'll see some improvement before then. I started on 15mg tablets and that was increased to 20mg after a couple of months as they felt that things weren't improving quickly enough.
Hi CheylannThey gave me 2x 10mg jabs and then Sunday week 3, I had to up it to the 15mg Jabs. During the first 2 weeks I felt quite rough as you know but (fingers crossed) this week I am fine. Maybe I had a bug or something during the first 2 injections 🤷♀️. I’m not as tired as I have been for months. Perhaps mine is starting to work for me 🤷♀️ X
That's what I'm hoping for. 10mgs is low but it may work. Doesn't make sense to start high. I'm sure they will increase it if necessary but nothing has been said yet.
It also might not suit you. That’s ok. There are others to try. It never worked for me and just made me feel poorly and depressed. Fingers crossed for you.
When I stopped taking mtx, it took weeks for the pain to come back. Apparently it's residual in the body for a while. I think it took six weeks to feel the effects when I first started it. Mtx has something to do with osteoporosis, too. Not long after r.a. diagnosis, I was tested for osteoporosis.
I’m not being rude, but please make sure you understand the information you’re giving out. That paper does not say mtx causes osteoporosis, or that it doesn’t help bones at all. What it says is that there are a few case reports of a minority of people that take mtx having what may have been stress fractures. It goes on to say that it’s possible that mtx may increase the likelihood of osteoporosis in those already prone to it:
‘The publications reviewed suggest, but not beyond doubt, that methotrexate may enhance osteoporosis. Especially in patients with inflammatory rheumatic diseases, already prone to osteoporosis, MTX might induce stress fractures…MTX may be an additive risk factor for stress fractures in arthritic patients, who are already “at risk” for (local or generalised) osteoporosis.’
They were writing it as a hypothetical possibility that was not proven according to the article itself, which was published in 2001; a quick root through Google shows our knowledge and understanding of the subject has moved on quite a bit in 20 years. Osteoporosis is a common comorbidity in inflammatory arthritis, but arising out of the inflammation of the disease alongside things like corticosteroid use. If you’d like some more recent information to read:
‘While studies have found that methotrexate can have a negative effect on bone density among those who take very, very high doses for cancer treatment, the much lower doses used in inflammatory arthritis don’t seem to carry the same risk. In a meta-analysis of six studies, there was no change in bone mineral density in the femur (the thigh bone) or in the lower spine for adults or children with RA on long-term, low-dose MTX.’
As per others, the guidance is you should hopefully be seeing some benefit within 12 weeks. However, in the absence of any or only very slight improvement, it may not be that they take you off it, it may be that they increase the dose, particularly as 10mg is so low. I started at 15mg, no response at all by 10 weeks, so went to 20mg. No response after another 10 weeks, added in leflunomide. Within a couple of weeks of adding the lef there was slight but steady improvement, but it was the lef on its own that worked for me, rather than the mtx doing anything. Eventually came off the mtx completely after a year and having been at the max therapeutic dose for 4 months (injecting 25mg), although I probably should have had it stopped and my meds switched up a couple of months prior to when I did. Hindsight is wonderful thing, and in my case, so was being able to see my own consultant rather than someone trying to assess me the way they would someone with RA rather than PsA.
As I think I’ve commented before, finding the right meds and the right dosage takes time, and even if mtx ultimately works brilliantly for you, it may take several months to get up to a properly therapeutic dose.
Thanks. Not sure I want to stay on a drug that doesn't work for so long. 10mgs might be low for you however it may be enough for me. If after 12 weeks it doesn't work I suppose they will increase it. I'm scared to add any drug that is in tablet form as worry about my stomach.One step at a time.
Yes, 10mg might well work for you, and fingers firmly crossed it does, but it is still a low dose, either way. The reason I say that is because the minimum therapeutic dose is 7.5mg, and the max is 25mg.
I do understand where you’re coming from, but you have to remember that once it’s decided a drug isn’t working, there’s no going back to it later. There are plenty of options, but equally, the list is finite; unless it was causing you intolerable problems, it would be a real shame to come off something after 3 months and say it definitely doesn’t work if putting the dose up would make a difference. Even if the dose was upped really quickly, because they average 12 weeks to work, for many DMARDs it would still probably take about 7 months minimum to get up to the max therapeutic dose.
I understand. It makes sense to start on the lowest possible dose and work your way up to maximum. That's what I'm saying so I will give it a good go but if after 12 weeks 10mgs isn't working then it will either have to be increased or changed. I just don't won't to be putting this strong drug in my body at the risk of damaging other organs for too long if it doesn't work. As far as I'm concerned if it hasn't worked in 6 months it probably won't.
It took 2 years for my dosage to be right. If there is no improvement after 3 months, then the dosage is increased incrementally. You are in this for the long haul. It is a chronic condition. Read NRAS website if you need further information.
Hi. We might be experienced but less of the old please. 🤣🤣(Only teasing.) Yes you are right, it is different for everyone. It is a long time since I started mxt and can't really remember. I know it can be 3 months before you get the full benefit. It sounds a long time when you are in pain but the mxt will be building up slowly and starting to work. It may work much quicker for you. You may have to increase your dosage at some point. Just keep your rheumy team informed. Remember they don't know how you are feeling unless you let them know. They want to take your pain away and slow down the RA as much as possible. Don't worry about contacting them. They are a friendly lot.
Hi I started on 15mg mtx in Nov 2020, after 4 weeks was to up it to 20mg, the advice & literature said it can take up to 12 weeks to work, couldn't feel any benefit at 12 weeks so consultant said to give it another 4 weeks 🙄, in the meantime I had a number of steroid injections & was also on etoricoxib, hydroxychloroquine & gabapentin.
After 16 weeks the consultant said to add in lefluminode at 10mg, still no real improvement, in September 2021 upped lefluminode to 20mg, after a few weeks could actually feel improvement 😀 but, developed a chest infection, the gp prescribed antibiotics & said to leave off the mtx for 2 weeks, I could feel my joints getting worse again, restarted mtx but the next dose failed (I was put on metoject back in October) had a massive flare & it was only at that point I realised how much mtx (along with the others I take) actually works.
Hope yours kicks in much sooner but don't be afraid to say to the RA team if its not working. X
Hi, well i don't want to burst your bubble, i have been on MTX for about 7 years along with Humira, and my RA is still active, i've complained to my rheumy nurse only to have an ultrasound on my hands, and to be told there is no sign of inflammation, so why do my hands swell up and other joints ache like hell??????? so no change in treatment so you can see that that the answer to your question from me is "How long is a piece rope " i wish you well
Isn't there a blood test that tests for inflammation? That's how the rheum knows if the med is working. At every visit, if I complained of pain, the dosage would get raised. A low dose doesn't get you that sick, but a higher one does. At one point, I had no pain! It was great. Then I stopped taking it before getting covid vax boostered , and a few weeks later, things started hurting again. But there was no pain for quite a while when I wasn't taking it. By the way, I called rheum office to let them know I wanted a drug holiday, and why. The office said they don't recommend it, but I did it anyway because everything I read about it made scientific sense, and, it wouldn't hurt anything to do so.
Not everyone has elevated inflammatory markers, even with very active disease. In some types of inflammatory arthritis, like psoriatic arthritis (PsA), the majority of patients will have completely normal esr and crp, even with massively swollen joints. A small proportion of people with RA, even if otherwise seropositive, also don’t mount a crp response during flares. It usually takes people with normal esr and crp a lot longer to get diagnosed correctly, and they’re often reliant on scans to demonstrate that there is active inflammation.
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