Methotrexate

[Pred60lady]

I have had pmr for 7 years and been treated on pred all that time. I have been still struggling so this week my Consultant suggested I try methotrexate, which I have agreed to. I know you have to be monitored closely but would be grateful for any helpful info about methotrexate as I am quite anxious about going on it?

[Celtic PMRGCAuk volunteer]

Hello Pred60lady, Methotrexate is often one of the first DMARDs (Disease-modifying anti-inflammatory drugs) to be prescribed when patients have difficulty reducing from the higher doses of Prednisolone. I haven't had any personal experience with MTX but I know several people who have tried it in an effort to more easily reduce their Prednisolone dose. As with all other drugs, it does prove successful for some whilst not making much difference for others, but you won't know until you try it. If it is going to work, it can take anything from 3-12 weeks to notice any improvement. It is taken once a week in tablet form but is also available by injection if side effects become a problem. Your Dr should also prescribe folic acid tablets to reduce the likelihood of side effects such as mouth ulcers.

I'm sure someone will come along with some helpful advice from their personal experience with MTX - meanwhile Arthritis Research UK have a helpful leaflet which is available free of charge from arthritisresearchuk.org, Tel [phone].

Finally, I assume that when reducing your Pred dose you have been trying one of the very slow reduction plans, slowly tapering to each new dose over a period of weeks rather than going straight from one new dose to the next?

[Pred60lady in reply to Celtic]

Hi, thank you for your reply, I really appreciate your advice. I do have a leaflet that is helpful but I go to the hospital on the 28th for an educational. Don't know if I will start treatment then. I am to have injections alongside my steroids and pray I can reduce and get right down. I have over the 7 years I've had this wretched pmr tapered off very, very slowly with no affect. Thanks again.

[savannahlady]

I have been on methotrexate for psoriatic arthritis for over two years. The process is normally to start you on a low dose and gradually increase as necessary to one that works. That point was reached for me on 17.5 mgs per week (7 tabs at 2.5mgs each) taken in one dose and followed three days later by 5mgs of folic acid. I had no adverse reactions and have gradually been able to reduce the dose to 7.5 per week and hope to come off it altogether by the end of the year. You will need to have regular liver function blood tests and others which your consultant may recommend. In the UK, methotrexate is a consultant only prescribed drug so you have to see your consultant regularly - I have seen mine every 3/4 months.

As it happens, I have now been told that the original diagnosis of psoriatic arthritis was incorrect and that whilst I may well have had late onset psoriasis (I am almost 70), my arthritis is osteoarthritis. However, the methotrexate did cause the psoriasis to clear up and for that I am enormously grateful.

As you may know, methotrexate is one of the oldest chemotherapy drugs and it's interesting that it is still being used as one of the most effective treatments for inflammatory conditions like psoriasis, rheumatoid arthritis and so on.

Good luck with your treatment!

[Pred60lady in reply to savannahlady]

Hi thank you so much for replying and am glad you have found that methotrexate has helped you. I know we are all different and my Consultant wants to give me injections first so it gets onto my system quickly and then go on to having an epipen. I go on the 28th for an educational and hope it will address my pmr better than the steroids!