Complications with MTX and post Covid

[Sebastian247]

Hi there. I wondered if I could get some thoughts on what has recently occurred. My MTX was increased 6 weeks ago, and I stopped prednisolone a week ago.

I had a blood test Tuesday. Thursday my GP phoned saying red and white cell count were really low, and to stop taking it until he'd spoken to rheumatology. My CRP was 10 which surprised me as my joints don't feel too bad.

I mentioned I'd had Covid three weeks earlier and still had a persistent bad cough and felt even more exhausted than normal. But he didn't think this was anything to do with the blood results. I was asked to have another blood test the following morning.

He phoned that evening saying latest bloods were back to normal and it was a probably a 'blip,' and could take MTX as normal. He mentioned CRP was now 24, more than doubled in 2.5 days.

I was in bed when he phoned having got home work from and had felt really unwell and totally exhausted.

I asked again if it was possible I was feeling so unwell because of the bloods but he didn't think so. But he said I could delay resuming MTX if I wanted in case I had a viral infection.

i don't know what to do. I feel ill but in different way from how I feel due to RA. My CRP has never gone up that fast and I would normally be in much more pain at that level. I actually thought the higher MTX dose might be working for me because my joint pain and swelling is all but gone and hasn't started to return after stopping prednisolone over a week.ago

I just wondered if I should restart the MTX and if the jump in my CRP could actually be due to something other than my RA, like a chest infection?

As always I'd be really grateful for any thoughts and advice. Seb.

[JenniferW]

Can you phone the rheumatology helpline? It sounds very complex.

[Sebastian247 in reply to JenniferW]

I guess so. The GP said he'd ask for their advice. But now the bloods are 'back to normal', apart from the CRP, I wonder if they'll feel any need to respond.

I'll see how things are on Monday. I'm in bed now. I've never felt so drained of energy.

Thanks.

Seb

[Katie-Mag]

Sorry to hear you’re feeling so lousy Seb. Certainly sounds like you need the experts here - your rheumatology helpline would be a good starting point.

Hope you’re on the mend very soon!

[Sebastian247 in reply to Katie-Mag]

Thanks Katie. I started feeling hot last night so took my temperature. It was 38.2, and 38.4 this morning. I think that confirms I have an infection as I suspected, probably on my chest. Shame the GP didn't really listen to me. I haven't re-started the MTX which is probably a good thing. I haven't decided whether to phone 111 today, or call my surgery on Monday.

My birthday today as well! Thanks for the kindness and advice.

Seb

[Deeb1764 in reply to Sebastian247]

Happy birthday not the best way to spend it 🤪

[Sebastian247 in reply to Deeb1764]

Thank you. No, not what I had in mind. Just phoned 111 and waiting for them to call back.

Still, all the coughing has given me the six pack of an 18 year old!

Cheers.

[janmary]

Happy birthday Seb. Think you should call 111 . Hope you feel better soon

[oldtimer2]

It does sound as if you have an infection. Best not to restart methotrexate until that's sorted out. rest, paracetamol, fluids etc....today. If you worsen then contact the 111.

[pippin_fort]

If it is any consolation my CRP post COVID a number of weeks later was 26. I too have never had it that high. I have got both forms of arthritis, severe asthma now and long covid after first being infected in March 2020 and again earlier this year. I think it may well be a Covid thing.

[Sebastian247 in reply to pippin_fort]

Thanks pippin and sorry you've had such a rotten time too. The CRP thing is odd, especially if it doesn't result in increased RA symptoms as normal.

I'm waiting for a second clinician call back from 111. The first thought it likely to be an infection. She asked me to do a Covid test. Really surprised its come up positive, although very faint, three weeks after having got Covid. Not sure what this means.

Hope things improve for you soon. Seb.

[Curious1248]

CRP is not specific to RA, so the increase just indicates increased inflammation. That and the fever might make sense with an infection. The rapid covid test can look "faintly positive" if one checks it a bit later than instructed.

[Sebastian247 in reply to Curious1248]

Thanks. My thinking too regarding the CRP. But my GP didn't seem to make the connection. Although faint the positive line appeared almost immediately.

Been prescribed wide spectrum antibiotics. Hopefully that'll fix me.

Best wishes.

[SueBaker]

You didn't just stop the prednisolone without tapering it down? You're really not supposed to do that

[Sebastian247 in reply to SueBaker]

No, I'm very used to taking pred and always follow the script.

Seb

[Sebastian247]

Thanks to everyone for offering advice and perspective.

Had a nightmare weekend trying to access the NHS. 111 sent me to a local MIU. On arrival they'd closed the unit due to overcapacity. They knew I was coming but that didn't change anything.

They said they hoped to reopen after two hours and invited me to come back. I just felt too ill to make the journey again with no guarantee I'd be seen.

Then they phoned at 9.30pm to say there were no GP appointments available anyway, and what did I plan to do!?

I got through to my surgery this morning and was prescribed antibiotics, although the GP was really unsure if I had an infection. As they didn't see me in-person of course it's guess work.

Temperature is 38.8 and I feel dreadful. Fingers crossed the antibiotics work.

Many thanks.

Seb