MTX and fatigue

[BeachsideVia]

I just started on MTX 4 weeks ago (pills, 17.5 mg) and so far I have had no major GI effects. Had a couple of painful joints (ankle, jaw) that lasted a day, much better than my recent 2 week flare! I feel a little less stiff in the morning too. However my fatigue is worse, if that could be possible! Ever since my cancer treatment I have had major fatigue… had to retire, cut back activities, and it has been progressing. I have had RA that whole time too, untreated.

I would like to know if MTX , after time, will help fatigue. Or is there another DMARD or biologic that helps more with fatigue. I have HBP and stimulants raise my BP. I have an appointment in May with an endocrinologist to evaluate adrenal function, but have had thyroid tests that show nothing.

on top of it all I have MGUS, and my hematologist says no problems!

[KittyJ]

aaah fatigue, a common problem here but unfortunately there’s no one thing that’ll solve that, especially as you had it before the mtx with the cancer treatment . Mtx can take a few months to fully work so hopefully once you’re on it a bit longer your RA will improve and fatigue symptoms may improve too but in the meantime rest when you need to and pace yourself, look after yourself and I hope you improve soon.

[smilelines]

maybe you won’t have any GI problems because mine started right and progressively got worse quickly . Hope your fatique lifts. I know my doctor said the side effects would lessen with time. Best wishes.

[Peacox]

I’m afraid MTX has made my fatigue much worse. I try to cope as I’ve tried all the other DMARDS & can’t tolerate them. I’m sorry to bring rubbish news. But everyone is different. So yours may improve. Time is the thing with MTX. I’m still waiting. Good luck!

[stbernhard]

Good morning , fatigue is a very complex thing. I'd recommend you read the NRAS leaflet "Fatigue Matters" on their website . MTX didn't cause fatigue for me. I've been taking it for over 10 years. The cancer treatment and coming of my RA drugs certainly did cause fatigue. All the best my friend.

[nomoreheels]

You are still relative new to MTX so there may be improvements the longer you are on it & the more it helps. Once you get to 12 weeks plus, that's when you will potentially feel the difference. That said I’ve been on MTX 14 years & have always been more tired the day after I inject, I’ve just come to accept it & try not to arrange anything of importance on Thursdays if I can. At least by the weekend it's more likely I'm on better form.

It may not be MTX though so be prepared. With RD's fatigue is a major symptom & may be not easily eased even when considered well controlled. It's a complex thing & even when trying to pace yourself you may find you still feel like you're walking through treacle.

[cyberbarn]

The first few weeks I was on MTX I had increased fatigue and headaches. The fatigue has eased a bit, but the headaches have carried on so the nurse has upped the folic acid to every day bar injection day rather than just the day before and after.

Have you been given a prescription for folic acid?

[Hidden]

Going gluten free (almost) and taking Amitriptyline 20mg @ 7pm so I sleep more soundly, helped me with fatigue. Pacing and resting took me 10 years to get my head around 🙄. One day on , one day off works for me… and stops you beating yourself up. I also sorted out my finances and took medical retirement. Stress is still the thing that makes me have to go to bed… and can wipe me out for a week..

[BeachsideVia]

thanks for your replies and sharing experience! I was prescribed folic acid 1 mg daily, nothing about eliminating on MTX day. I take Cymbalts for peripheral neuropathy, and I sleep well ……. Too well! I can see how things will improve over time. I am hopeful the flares are over for now. I planned my life around the expectation of a flare, so I do nothing. With the hope of improvement I am doing more now, but I still crash around mid afternoon. Then… my long nap until dinner.

[Runrig01 in reply to BeachsideVia]

I would speak to your rheumatologist, most of us who take it 6 days a week are on 5mg a day, to reduce side effects. I would also question re you taking it on the same day as MTX, as it’s shown to reduce the effectiveness of the MTX. I’ve attached the nhs info re MTX, if you scroll down to the yellow box, you will see they stress about not taking on the same day. The 5mg dose may well help lessen the side effects.

nhs.uk/medicines/methotrexate/

[KittyJ in reply to Runrig01]

BeachsideVia is in the US, they take it differently.