Methotrexate and folic acid: Hey Fam I'm starting... - NRAS

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Methotrexate and folic acid

1bozyact profile image
29 Replies

Hey Fam

I'm starting these meds tomorrow 10 mg methotrexate weekly and 1mg folic acid daily. i have read several post about these meds and feel a little better about taking them. Most post are for RA, but i have OA in multiple joints and it's been miserable for the last month or more. The joint pain and stiffness have been unbearable. Looking forward to some relief. Is there anyone else on the platform with OA?

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1bozyact
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29 Replies
Neonkittie17 profile image
Neonkittie17

It is indeed an awful painful time awaiting starting meds and not having RA under control but you will get it under control. It can never happen soon enough when you feel in agony each time you move. Many of us with RA on here also have OA joint damage as the joints have been eroded by the rheumatoid. A lot of people on here have had joints replaced very successfully. I hope Mtx is soon protecting your joints and the OA discomfort and pain is being addressed too. Mtx has been a really good med for me. I hope you feel improvement on Mtx but if can take some weeks to happen. Around 8 to feel a distinct improvement for me. Good luck. 🙏🏻

1bozyact profile image
1bozyact in reply to Neonkittie17

Thanks so much for the information and your words of support and comfort.

helixhelix profile image
helixhelix

I have both, and often the OA is worse that RA as there is so little that can be done until you get to the stage of joint replacement. So as well as the RA drugs like Methotrexate I take painkillers and anti-inflammatories for the OA.

Jackie1947 profile image
Jackie1947 in reply to helixhelix

My Consultant took me off anti- inflammatory drug Naproxen because I was on it a long time which increases the risk of heart attack and strokes and also having RA that alone upps the risk. Happy days!

bpeal1 profile image
bpeal1 in reply to Jackie1947

Different consultants have different views on this. I’ve been taking Naproxen for years and mentioned it to my consultant a while ago. Her opinion was the risk of heart disease was greater from RA inflammation than it was from naproxen so as naproxen was helping to reduce this it was safer to stay on it.

Briefencounter profile image
Briefencounter in reply to bpeal1

Happy to read this . I was on meloxicam for years until the beginning of this year when I sustained two hip fractures due to a previous fall . My consultant changed my NSAID to naproxen. This worked brilliantly for me and not only helped with the hip pain but all the other aches and pains due to RA .

After two months I was told to taper off . As I did so all the pain returned. I asked if I could stay on naproxen but was told "no" because of the risks of heart attacks and stroke ( especially at my age , 81 ) . I did mention the fact that my RA , being an inflammatory disease , posed a similar risk but this was ignored . I'll have another attempt at my next consultation.

helixhelix profile image
helixhelix in reply to Briefencounter

maybe ask for a cardiac assessment if they are concerned? Sure there’s a risk, eveything has a risk. But if it is a well managed one then that works for me, so if you don’t have other risk fa tors apart from age then ask again?

I don’t have high blood pressure, my cholesterol is not brillant but ok, I don’t smoke and am normal weight, take daily exercuse and have a good diet (lots of plants and low on fats and sugars). So having managed as many cardiac risk factors as I can, for me the risk of NSAIDs is acceptable. My body, my choice!

Briefencounter profile image
Briefencounter in reply to helixhelix

Hi Helix , thanks for your reply . I agree completely with your last sentiment . I do have slightly high BP and triglycerides- both managed by pills . I'm a few pounds overweight, but addressing that .

I'm fortunate that I have a doctor who believes in upholding her side of the "shared care" aspect of RA . So I have a RA annual review with her . The HCA does all the preliminary stuff like height , weight , FBC , BP etc . Then I have a 20 minute review with my doctor to discuss the results .

I've just had my review and she is happy to prescribe naproxen, as long as I stick to the rules , ie only take it when I really need to and " as low a dose as possible , for as short a time as possible" .

I find that if I take one 500 mg naproxen in the morning then this helps with the pain/stiffness for nearly a week ( give or take a day , depending on how Im feeling ) , before I need to take one again . She seems happy with this so I hope my rheumatologist will agree .

Jackie1947 profile image
Jackie1947 in reply to bpeal1

Fortunately the Benipali has done the job Naproxen did.

Jackie1947 profile image
Jackie1947

Excuse my ignorance but I had no idea Mtx was prescribed for OA it not being an auto immune disease but wear and tear. I have RA and OA came first but wasn't prescribed anything major for it . Although both affect the joints they are a world apart but pain is pain.

helixhelix profile image
helixhelix in reply to Jackie1947

it isn’t! So guess OP does have RA as well as OA.

Jackie1947 profile image
Jackie1947 in reply to helixhelix

Why thank you !

Remember NOT to take folic on your Mtx day. For my OA I take calcium and vitamin D on top of the Sulfasalazine and Mtx I take for my RA.

No painkillers worked for me, despite being on diclofenac and naproxen for years. Now I take Amitriptyline which has made a huge difference. I have Fibromyalgia too though.

If I’m reallybad, I just put the heating on and go to bed. A couple of paracetamol also help; cocodamol was useless for me also🙄. Tbh, deep heat or vicks vapours works better than the tablets. I also have piroxicam gel.

stbernhard profile image
stbernhard

I have OA and the best medicine for me is regular exercises for the joints that hurt. It's painful to do , but without doing them it's even worse. I got exercises online from NHS, NRAS and many other places on YouTube. Maybe you do this already, but if not please give it a try. I hope your pain gets better.

1bozyact profile image
1bozyact

Thanks for the comments, I did ask my rhemy about the mtx and he said it's used for different types of inflammation. I was concerned about taking, because I was diagnosed with Ra, the Prednisone worked, but once I tapered off the pain returned. I'm allergic to sulfa, so can't take anything that has sulfates in it. I do Tai chi twice a day and when I feel stiff I get up and walk. Why can't I take the mtx and folic on the same day?

1bozyact profile image
1bozyact

Was not diagnosed with ra

helixhelix profile image
helixhelix in reply to 1bozyact

don’t understand? In the post above you said:

“because I was diagnosed with Ra, the Prednisone worked, but once I tapered off the pain returned”.

1bozyact profile image
1bozyact in reply to helixhelix

I wasn't diagnosed with Ra,. When I googled information for mtx, it lead me to this platform, will look for a platform for OA, but you guys have helped me a lot. Thanks

helixhelix profile image
helixhelix in reply to 1bozyact

we cover all sorts, jia, psa, as, ra and since lots of us have oas that too, so you are very welcome.

I am not a doctor, but have been involved in this forum for 12 years now (I think!). So have a bit of experience of hearing hundred’s of people’s stories. And I would be questioning your doctor hard as to why you have been prescribed MTX. I have never heard it used for anything that is not inflammatory in nature?

It could well be that your doc is using it as a diagnostic - so if it works then shows your blood tests are not telling the full story. It is a valid thing to do.

in reply to 1bozyact

I have to agree with Helixhelix in saying I would be asking your doctor for clarification as to why she’s prescribed you immunosuppressant medication for OA. Methotrexate and the other DMARDS people talk about on here (including Avara, which is a brand of leflunomide) don’t do anything for OA, they’re only useful for types of autoimmune inflammatory arthritis like RA, PsA, AS etc. I’m not medically qualified, but it would seem very strange to me that you’ve been prescribed these meds without an inflammatory arthritis diagnosis, or at the very least some major suspicion that it is an underlying issue.

1bozyact profile image
1bozyact in reply to

Thanks for looking out, I've been dealing with this unknown/ in-between arthritis for awhile. He knows I have OA in multiple joints, but my labs show inflammation too. So from reading some of your post and what's he's telling me, I believe Ra is coming.

helixhelix profile image
helixhelix in reply to 1bozyact

sadly I think you might be right. But never stop askimg your doctor questions.

NRAS is for people with RA. If you ‘only’ have OA, you may be better joining their forum as well..

Not that you aren’t welcome here obviously… but the advice may not always be pertinent. Not everyone reads the bios x

As to the ‘folic acid’ question. I have no idea why we don’t take folic on Mtx day. I think it’s because it affects the absorption (though can’t actually remember 🙄😂).

nomoreheels profile image
nomoreheels

Hiya 1bozyact, welcome. As has been already said many of us with RD also have OA. I was diagnosed with secondary OA at the same time I received my RD diagnosis at 48 in 1998. That said because many do have OA you may find it helpful to stick around.

At my latest Rheumy appointment I queried if it was possible my MTX, which I've been on for 13 years, worked on my OA too. I asked because after my latest Covid vaccine (3rd booster) I halted injecting MTX as per British Rheumatoid Society suggestions & not only did my RD flare but my OA pain hit new levels, especially my hands. I was told it's now thought it does have some effect on OA so I did some rooting about & it does seem that if prescribed early enough it can have some positive action on erosion. Not so much pain though so pain relief (& usually an NSAID) should be coprescribed, which until now have been the only meds used, as well as exercise. I'm prescribed quite strong pain relief as some joints are now bone on bone so very ouchy. I think it's only been studied on hands & knees but the point being there is obviously a reason your medic prescribed it for your OA affected joints & was confident enough you'd have positive results.

If I may mention something about sulfasalazine. The 'sulfa' components aren't sulfates, they are sulfonamides, quite different. So you should be able to take SSZ if it's an option offered to you. Do check with your medical professional although for reassurance.I think you may be able to take your folic acid on the same day being low dose. Some countries, including the US only prescribe 1 mg. Those who have replied are in the UK (this is a UK charity although we welcome anyone from anywhere). Here we are prescribed 5 mg per day, except MTX day. This is because it may affect absorption at that dose. I take 6 x 5mg weekly so quite a bit higher. Do double check if you should take it the same day though, then you are clear.

I hope some of this is helpful & you enjoy being here.

1bozyact profile image
1bozyact in reply to nomoreheels

Thanks nomoreheels, love, love the name! I am staying, the information I receive really helps, I did join a OA platform too. I do Tai chi several times a day and walk around the house when I feel I'm getting stiff. This cold weather doesn't help, when I do go out, I layer, layer up. Has anyone tried hot wax on your hands and feet? It really helps the joints, love it!

nomoreheels profile image
nomoreheels in reply to 1bozyact

I made an error, I was diagnosed in 2008! My username doesn't really fit any more as my feet have altered in the time since I joined meaning I need to wear a block heel or a wedge. I have to say it is so much nicer than wearing flats & more comfortable.

I'm pleased you've found it helpful & hope you don't have too many reasons to post, in the nicest way. Join in replying on others as well if you feel you can help or need more info, it's all about support & sharing experiences. You can learn a lot just by being here.

With OA it's good not to root yourself for too long. I find my OA raises it's ugly head in the evenings when I'm starting to relax so every hour or so I get up & just walk around which is nice in the summer when we still have daylight as I take a stroll around the garden but not so much now the nights are drawing in. We have a 41/2 month old puppy so she's keeping me on my toes, I'm up plenty for garden time if you know what I mean! Tai chi will be good, it should improve function & the strength of your muscles which will benefit in supporting your joints. 

Hot wax is wonderful, especially for my hands. Many of us here have at least tried it once. My fingers aren't in a good state but I find exercising them with the wax still on makes is so much less ouchy.

Happy5 profile image
Happy5

Yup my OA led to hip replacements which makes it much better pain wise.

My knees though are another OA story and I use paracetamol or co-codamol if too bad.

Thing is the treatment for RA will help ease symptoms for OA once it's in your system and working as it should. As others have said the RA is damaging joints causing OA symptoms.

Talk to your rheumy team especially the nurses who have loads of knowledge about reducing symptoms, don't suffer they're more than happy to help find solutions. Hang in 😊

1bozyact profile image
1bozyact

Happy Saturday

Has anyone heard of drinking tart cherry juice to help with inflammation?

nomoreheels profile image
nomoreheels in reply to 1bozyact

It seems more of an American thing, tart cherry juice. I think usually it's our US members asking the question or saying that they've tried it. As such I personally don't know if it helps & it's only recently I've seen it in shops here, just one make, & only then it's a juice drink so not high in actual fruit. I’m not sure how effective it would be at easing inflammation but then I have meds for that so not on the look out for an alternative source. I don't see any harm in trying it though, as long as it doesn’t interact with any meds you're taking, just opt for the brand highest in actual cherry. Anything labelled drink will always have more water than fruit. If you're after higher quantity fruit then look for fruit juice (in this case tart cherry), if it's available.

Just a heads up, you may receive more replies by starting another post if you have a different question. Only because if in the meantime someone replies to your original question this one is less likely to be noticed.

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