MTX 5 mg/week

[HGCCNM]

Hi,

I am interested if anyone has treated their RA with only 5 mg of methotrexate weekly. I was prescribed 7.5mg x 2 weeks, then was supposed to increase to 15 mg. In less than 3 months I have lost an alarming amount of hair. It started the first week so my rheumatologist suggested I not increase my dose. 2 weeks ago I decided to decrease to 5 mg. I see my rheumatologist this week.

This is my back story:

I have had Hashimoto’s thryoiditis for 30 years, well-controlled. I had chillnlains/pernio but not recently. Dry eyes started 2-3 years ago. ANA+ then, but RF and CCP not checked.One sore finger joint and morning hand stiffness so checked RF and CCP. RF negative, CCP > 300. ANA 1:80. CRP and ESR normal.

Started oral methotrexate 7.5 mg/week and immediately started losing an alarming amount of hair. Two weeks ago I dropped my dose to 5 mg/week. I weigh 50 kg, BMI 19. X-ray and MRI of hand shows “osteoarthritis” as read by the radiologist.

[Runrig01]

I had thinning of my hair initially, but it settled down, fairly quickly. Do you take folic acid once a week, or daily except MTX day?.

[HGCCNM in reply to Runrig01]

Thanks for your reply. Yes, I take folic acid, methylated folate and folinic acid 6 days/week. I also take biotin and use a shampoo and conditioner that are supposed to help with hair loss. I only wash my hair every two days even though it needs daily washing. The shower and hair brush total wad of hair covers the palm of my hand — each time! I’m hoping that lowering the MTX to 5 mg will help decrease hair loss, but still be therapeutic…

[helixhelix]

The lowest dose of methotrexate that is therapeutic is said to be 10mg. So chances are that 5mg won’t do anything for your RA, sorry.

When I started my hair thinned badly, but it settled down after 6 months,

[Maisie1958]

Hello, I did get hair thinning when I started on 15mg MTX but settled down after about 10 weeks. I’ve reduced to 10mg MTX weekly after two years and doing fine. My lovely Rheumatologist did say it’s unlikely I would be able to reduce further and still have good control. I will slowly try to reduce probably 😊. No problems on 10mg weekly atm.

Will be interested to hear how you get on. All good wishes.

PS I weigh considerably more than you do sadly 😊

[SueB]

I’ve had RA since 2009. I was initially started on 7.5mg of mtx with plan to move up to 17.5mg in stages. However I never got above 10mg because my neutrophils kept dropping below recommended levels. However mtx plus hydroxychloroqine worked for me. I’ve been in clinical remission since 2014. I’ve only been on 7.5 mg since then but my RA is well controlled .Neutrophils are still an issue- rarely get above 1.3 but that’s anouther story. I hope the low dose works for you.

[virtualreality]

Sorry to hear how bad the hair loss is for you, it's hard to deal with on top of RA itself. How have your symptoms been over the past few months on MTX, has it helped yet? If it isn't effective after 4 or 5 months and/or the side effects are not manageable for you, there are alternative medications that could be tried. I hope your appointment with your rheumatologist this week is / was helpful in deciding how to proceed with treatment. It can be such a delicate balancing act, managing symptoms and side effects.

[HGCCNM]

Thanks Everyone! I appreciate all the input and insight.

I saw my rheumatologist two days ago. He recommended I increase from Methotrexate 5 mg to 7.5 mg, divided into 3 doses over 24 hours, if tolerable. He also said I could consider switching to Leflunomide instead.

I am grateful that I have no pain and my hand MRI shows no erosion. My CRP and ESR are normal. My anti-CCP antibodies are >300 and my ANA is 1:80, speckled. Because of the anti-CCP and episcleritis and the stiffness in my fingers, I was diagnosed with RA and Rx’d MTX about 3 months ago.

What gives me the most positive feedback and overall good feeling is exercise. I never come back from a walk wishing I hadn’t gone. My rheumatologist says, “Motion is lotion.”