Methotrexate & Covid

[Pollyanna16]

I am sure this came up when we were discussing Covid in the early days. I have been talking to a lady today who has PMR & Fibro & is wondering if Methotrexate suppresses the immune system so much it would make her more susceptible to Covid. Could someone advise? Thanks

[Hidden]

I believe general advice from rheumatologists is to keep going as usual with meds. I am on another dmard and the advice to me is if I get an infection...i.e. a cold then I should stop it for a week. I am still having my quarterly blood tests and have contact details for the rheumatology department to check for advice directly if unsure about my treatment plan.

[Pollyanna16 in reply to Hidden]

She wouldn’t drop her medication I am sure she just wonders if it makes her more susceptible to Covid

[SheffieldJane in reply to Pollyanna16]

My Rheumatologist declined to prescribe it for me because Covid 19 had started. This may have been different had I already been taking it. This was for suspected Large Cell Vasculitis . I assumed this was because of vulnerability issues.

[Pollyanna16 in reply to SheffieldJane]

Thank you Jane

[Hidden in reply to SheffieldJane]

It might well have been because lots of blood test etc are required and close monitoring, combined with potential side effects from a new drug, higher pred now and susceptibility.

[SheffieldJane in reply to Hidden]

That’s true. I didn’t really push it, it’s not something I want to take. I just got the impression that she was shelving a plan of treatment until the Pandemic was over and then GCA happened anyway.

[Hidden in reply to Pollyanna16]

If it's helping the PMR then it might be worth it, if not then that's a decision that needs to be made in any case with the rheumatologist. S/he should be isolating and following protocols for stringent social distance at the minimum. I think the dmard I take, which works on the same lines, works for me with minimal side effects so far in (3yrs). I don't even think about susceptibility as I am socially isolated and have generally been since day 1. You/one may be at more risk due to suppressed immune system, but seeing as otherwise healthy people have caught it then the risk is there for all. It's also about age, co-morbidities and general history. High BMI and high blood pressure is probably more if an issue if you get it.

My view all along has been if I keep my bubble intact as far as possible, wash my hands, dont touch my face, I clean all food and meds and try and leave all packaging outside until it can be burned. I have had to have blood test that were done as safely as possible, I wore a mask and do so in the garden of my terraced house with shared yards and don't go out if kids are playing.

But everyone has to decide for themselves what the calculated risk is whilst ensuring they don't allow PMR or GCA inflammation to do damage. Going shopping or for a walk in a crowded park makes you more susceptible that stay at home on pred and dmard....

[Pollyanna16 in reply to Hidden]

Yes she’s being exceptionally careful actually & indeed may have had COVID in February but hasn’t been tested. Ofcourse! Nothing you can do just take great care .

[Hidden in reply to Pollyanna16]

Yes. I had a bit of a sore throat and headache etc at the beginning do.hoping antibody test comes along. If they have found it as far back as November in French records then a few of us could have had it. I know lots of people last year who had persistent coughs for months!

[Yellowbluebell in reply to Hidden]

We both had dodgy symptoms at the start of this didnt we and it would be interesting to find out if we both just sailed through having covid or not!!

[Hidden in reply to Yellowbluebell]

As soon as we can get antibody test. I did feel rough for a couple of weeks minimum. But then it was manic on the forum for that time, my blood pressure was 😱 so you never know.

[Yellowbluebell in reply to Hidden]

It could in all fairness have been anything and yes the forum was mental then with the covid queries so we were probably stressed as well. Even me the unstressable one!!

[Brantuk]

When I had my surgery two years ago - they stopped my mtx for a month before the op so my body could cope with likely infection better - and restarted it a month after when I was on the mend. So when the corona thing hit I stopped my mtx for a couple of weeks to boost my immune system "just in case". However, rheumy advice was to continue with the mtx and ensure I don't get the virus by shielding. So I resumed the regular dose. To answer your question specifically - stopping mtx will make your body less able to cope if you get the virus - but it won't make you more likely to acquire the virus, which is entirely dependent on exposure.

[dancersize2 in reply to Brantuk]

I thought the MTX took several weeks before it started working so assumed it would take several weeks to be not working. I'm trying to reduce pred from 2mg and asked rheumy if I should reduce the MTX to 10 weekly instead of 20 at the same time. Her reply was work on getting off pred then we'll deal with MTX.

[Pollyanna16 in reply to Brantuk]

Thank you for the very clear answer! Take care x

[PMRpro Ambassador]

It DOES suppress the immune system and is one of the drugs on the flowchart thing for assessing level of vulnerability. If she were to get it she'd have to stop it - whether it significantly affects whether or not you get it in the first place is unknown, after all, very healthy young people with decent immune systems CATCH it - where the problem is likely to arise is in fighting it off. There is no cure or proven reliable treatment - it is a case of supportive measures until the immune system fights it off itself. mtx is stopped for the duration in any infection that is more than a minor cold to give the immune system a better chance.

It's not going to help fibro and it may not help reduce pred in PMR - but that is the usual discussion we have. So the other question becomes: Is she already on mtx? If she isn't. I doubt the question will arise until it is far safer to attend for regular blood tests. And I wouldn't be enthusiastic at any time personally.

[Occhealth]

Hi no one is more to susceptible to Covid we all have the same risk of catching it its a new virus which none of us have immunity to, the problem we have with compromised immune systems is that should we contract Covid we are at risk of serious illness.

[Blackcat1M]

Hi, I had to stop Mtx early in the year due to two courses of antibiotics, but afterwards my rheumatologist started me back on 20mg mtx per week.

Fingers crossed so far good, but I am having 2 weekly blood checks at my gp surgery.