Hydroxvchloroquine or Methotrexate

Have new consultant who wants to change my dmard to methotrexate but I am really concerned because I am on blood thinners for past DVTs, have atrial fibrillation and low blood pressure.

I was diagnosed with RA in March and saw a consultant who decided the best treatment for me was a high dose of steroids over a four month period along with Hydroxvchloroquine, alendronic acid weekly, calciferol.

Prednisolone 20mg for month decreasing each month by 5mg until fourth month of just 5mg.

From my first major flare in March which left me almost bedridden with swellings and pain and seeing this consultant in May the combination of drugs worked wonders within a month. I am back in my garden and busy as I can be again, pain free although can't seem to stop!

The new consultant wants to change the Dmards to methotrexate even with my other conditions.

He wants me closely monitored blood tests etc., X-rays and bloods before starting methotrexate and I am worried about negative interaction between the different types of drugs.

I am 81 tomorrow 🎂🎈 have no twisted bones at present, although there is RA history in my family, my late father was crippled with it from his mid 40s.

Can anyone give their experiences to quandaries on what to do.

Thank you

[Pebblescat]

Hi Ernie52. I was previously on Hydrocloxiclorine and am now on Methotrexate. I’ve had different issues with both of them but generally Methotrexate works best for me. I would say that the main question to ask is why the new consultant wants to move you away from a therapy that clearly works for you and that you are happy with. I can’t see any benefit in changing unless they can give you a compelling reason

[Hidden in reply to Pebblescat]

Thanks that is my thinking too.

[helixhelix]

It is quite common that prednisone is given to start with to calm everything down (which it often does - brilliantly!). But it is not a recommended drug for the long term because of the risks it carries.

So my guess (and it is just a guess) is that your new consultant has assessed that Hydroxychloroquine is unlikely to be effective for you in its own and wants to swap you to something a bit more robust before the steroids are completely gone.

You are well monitored on MTX, so any issues should be picked up quickly.

And happy birthday!

[Hidden in reply to helixhelix]

Thank you for your reply and your wishes.

[Knip]

Ernie, what blood thinner are you on? I'm on Clopidogrel (a blood thinner) because of a small stroke six years ago, and also have Methotrexate. I haven't had any problems and have been having both drugs along with others ever since then. Hope that helps. If you are on Warfarin, you may need to talk to your GP. Take care. Knip

[Hidden in reply to Knip]

Hi KnipI'm on Rivaoxaban blood thinner and bisoporol for my atrial fibrillation.

[Fra22-57]

If you are happy on what you are on and it’s working for you just say you would rather stay as you are for now.Just ask if to leave it for now til next appointment.

[Knip in reply to Fra22-57]

Looks as if I missed wishing you Happy Birthday! Hope you have a good day.

[Fra22-57 in reply to Knip]

Thanks but not my birthday until January 😀

[Gnarli]

Happy birthday Ernie52!

[Hidden in reply to Gnarli]

Thank you 😊

[Garnacha]

Just wanted to add I agree with helixhelix

Happy birthday 🎂 🥳 hope you have a fab day x

[nomoreheels]

Hiya Ernie. Firstly, happy birthday wishes. I hope you have a lovely day.

My experience of the two DMARDs was more clear cut, hydroxychloroquine (my first DMARD) just stopped working & methotrexate was the choice discussed with my Consultant. It turned out to be a good one as I'm still on it 13 years later. My thoughts about yours wanting to change up are similar to helix, that once prednisolone is out of your system HCQ may not be enough on it's own to control you, your Consultant will not want to see you returning to your unmedicated state. You see HCQ only has 2 daily doses, 200mg or 400mg, so little room for increase, no room if you're prescribed 400mg daily. MTX however has multiple options, from it's lowest dose, 2.5mg to 30mg weekly, although starting dose is usually 10mg, or more likely 15mg weekly, dose amended on results < or > It's also the more commonly prescribed med for RD. You'll find most here have been on MTX, usually at the start of their journey. I hesitate to say HCQ is milder but it is more frequently the first DMARD in less severe cases, or if there are other considerations.

The alendronic acid & calciferol were most likely prescribed to protect the density of your bones whilst taking prednisolone. He may wish you to continue on them, or order a DEXA scan to determine if you need to.

I can't help with experience of blood thinners I’m afraid but I’m sure this & your other conditions have been taken into consideration before his recommendation. It is common to have both a blood test & chest X-ray to have a baseline image of your lungs (& check they are fine to proceed on MTX). Further, with a new DMARD it's normal to have fortnightly drug monitoring blood tests for around 6 weeks. After that we normally go on to monthly blood tests to check it is doing what it should & it's not causing anything untoward. Once settled it may be that you only need to have 3 monthly bloods, though this will be your Consultant's decision, considering your age & other conditions he may wish to monitor you more closely & remain on monthly bloods.

I hope you continue to be able to enjoy your garden & also find it helpful being here.

[Hidden in reply to nomoreheels]

Thank you for such an informative post

[Sheila_G]

Don't worry. I had a TIA 4 years ago and I am on blood thinners as well as mxt. No problems