How long do I give methotrexate

[Gottarelax]

I've been on Methotrexate for 2 months now. In Dec I started a 4 week course of prednisolone because symptoms were still intolerable and I've been off a few days now. Day by day I'm going back to how I was, only worse because I came off Naproxen when I started pred on the Dr's advice. My MTX was increased to 25mg at the beginning of Dec and while I'm tolerating it well, I am just not getting any benefit that I can tell. I'll not be seeing the nurse for another 2 months ...do I just wait it out and hope or should I be flagging that it's not helping sooner?

[Gottarelax]

Thanks Ajay, Sounds like my nurse's appointment is going to be perfectly timed at around 4 months (assuming that the appointment comes through). I will just have to practice patience. I really do hope that it works because I don't appear to have side effects other than a little acid reflux which is probably more down to Christmas indulgences. In the meantime, I'll have to take it easier I guess.

[Runrig01]

I was told to allow 3-6 months. Like you i tolerate it well and was quickly increased to 25mg. You next appointment sounds like it’s scheduled for the time they would expect you to have some improvement. Normally you can continue nsaids or even prednisolone whilst taking MTX. Naproxen can be quite harsh on the stomach, so you Mail find a Cox inhibitor better.

[Ascidian]

I felt at least some (small) benefit after about 10 weeks, but didn't feel it was fully working. Couldn't get to see rheumy at the time, so I just had to stick it out. After 11 months, I suddenly felt amazing and still do - some 10 months later. So I think there is no hard and fast rule, but if you feel no benefit at all after 4 months, I think it would be reasonable to ask if it is ever going to work for you

[Boxerlady]

I'd say that it might be worth ringing them in a month if things aren't improving just to check if they want you to wait another month or if they want to see you sooner. My nurses prefer me to keep them updated rather than to suffer in silence. It may be that you need another medication added. I started on Methotrexate and Hydroxychloroquin and it was explained to me that although Hydroxychloroquin is a relatively mild medication, it acts as an enabler so that Methotrexate is more effective. Eventually Sulphasalzine was added after a flare and that's when things really improved for me. I should be having my annual consultant appointment in a month or so and will be interested to see if he wants to tweak things again as my wrist is not "right" although bearable.

[Knit12]

it takes approximately 12 weeks for methotrexate to be fully working in your system which would explain why you are not seeing any effect. I remember when I came off it I had 6 weeks with no meds to have it clear my system before starting anything else.

[Dobcross1]

Hi, it took around 14 weeks for MTX to work for me so hopefully you will start to benefit soon 🤞

[stbernhard]

Very glad that you don't have side effects. Stick with it. Give it a couple months. Good luck 🤞😃

[snotts]

It took 4 months to start feeling a benefit but the improvements continued for at least a year. Waiting for it to kick in was mentally very tough - just when I'd given up on it I started to feel better. Hang in there and I hope you get some relief soon

[Nuttyshirlz]

I agree with everyone else as my nurse told me yrs ago when I first started taking it you have to go up to the top of the rough hill to get over it then it’s smooth all the way down and not to over think about it lol and I’m still on it 6yrs later.

[Sheila_G]

Hi. I don't think 2 months is a long time. It can take 3 to 6 months depending on the person. I would stay with it for another couple of months before deciding if isn't working. I know that seems a long time but if you stop it you have to start again on something else. Give it a proper chance. It might be just the thing for you when it kicks in properly. Good luck

[Gottarelax]

Thank you all for advice and encouragement. I'm just going to have to give it more time. I really hope it kicks in soon!

[Nanna71]

I did not notice any difference for almost a year, but when it kicked in, it was awesome. I did not give up on my prednisone until I was good on MTX. After that, I tapered the prednisone until I went to zero December 2021. Now I use prednisone when I have a flare coming on so I can get some sleep at night. I take 25MTX weekly, sulfasalazine 4 tablets daily, and of course, folic acid 5mgs 6 days a week. I am in remission now. Patience is necessary. Most people have results before a year but average is 6 months.

[Deeb1764]

I did 12 weeks and had absolutely no difference just side effects then I had antibiotics with MTX landed up Anaphylactic so I was taken off MTX. My consultant said if absolutely no difference you have tried and we need to move on!

[nomoreheels]

From experience, if yours was to be the same as mine, you'd notice a difference if you had a dose reduction or, dare I say it, paused it or stopped it for any length of time. It's often written in sites I’ve happened upon that whilst 12 weeks is the time by which you should see results it can take quite a bit longer to achieve it's full full potential. Certainly 8 weeks isn't very long & your GP prescribing prednisolone was quite normal to help reduce the inflammation. I was prescribed a corticosteroid when I was diagnosed to take alongside my DMARD & 2 NSAIDs. As with anything RD though, it's all down to our different responses so there's no saying for sure whether this is it for you with MTX or if perhaps another DMARD (double therapy) would be needed. Or, I would think as you'll be on tablets, a change to injections will give another half dose or so for the same mg. It is early days though. When you next see your Nurse she will advise the best course of action.

Now you’re off prednisolone can you not start taking your naproxen again, along with a PPI? It's just as you say you're going back to how you were you need help to keep inflammation in check. If you're not sure I’d ask your GP but I see no reason he'd not say it's ok to resume it. I’ve been on pred for nearly 10 years & in that time always taken my NSAID etoricoxib. Anyway, there may have been a particular reason so check then you're sure.

[TheBoys]

it’s never worked for me at all.

[Hidden]

It can take a while to ‘kick in’. I take Sulfasalazine twice a day as well as 25mg Mtx. Everyone is different. It took me about 2 years (from diagnosis) before things started to get better.