Methotrexate and rib pain

[Linny3]

I am on week 3 of methotrexate by injection (low dose)

I have developed a severe pain in my side in the rib cage. It hurts to take a deep breath.Having a very hard time deciding if it is the mtx , the pmr or the prednisone.

I haven't had any other side effect with the mtx.

I had this once before a year ago and the dr. at the hospital said it was Costochondritis and gave me a steroid shot. It cleared after awhile.

Now the dr. say it is possibly a ligament problem but offered no help except for a muscle relaxer.

I was wondering if this is a side effect of mtx that others have noticed.

Thanks for your reply.

[MrsNails]

Hi Linny, It’s not a side effect l’ve experienced, have you checked the Patient Information Leaflet?

I too have had Costochrondritis & my GP gave me an Anti Inflammatory which cleared it up.

MrsN

[Linny3 in reply to MrsNails]

Thanks for the replyThe only thing I read was side pain but not sure what they mean.

[MrsNails in reply to Linny3]

I have the injections too - so l’ll have a read of mine & see if l can work out what they mean! It’ll be later as l’ve just slumped on the Sofa! 😉What muscle relaxant did they prescribe you?

[PMRpro Ambassador in reply to MrsNails]

I can't find anything except one reference to "low back and side pain" and I can't find a why! Except it fits with renal problems and mmtx can do that.

[MrsNails in reply to PMRpro]

Might be a bit soon to impact on the Kidneys? l’ll have a look at my PIL when l go up.

[PMRpro Ambassador in reply to MrsNails]

Maybe. But Linny has had costochondritis before hasn't she - perhaps coincidence? Though I ached all over very quickly , well within a month.

[Linny3 in reply to MrsNails]

I have skelaxin. It helps some but not very much

[Linny3 in reply to MrsNails]

what kind of anti inflammatory?

[MrsNails]

Hi Linny, l’ve just checked my PIL - l have MTX Metoject & there’s no reference to Rib Pain - l would suggest you ring your Rheumy Team on Monday as they are the real Experts in MTX

Good Luck & let us now how you get on.

Kind Regards

MrsN

[Linny3 in reply to MrsNails]

Thanks I think I will. Unfortunately, whenever I have a question, they almost always say 'see your GP'. I don't find my GP veery helpful when it comes to anything pmr related.

[MrsNails in reply to Linny3]

That’s not good, my GP always defers to the Rheumy Team - they never harass me about my Pred Dose but any MTX Related Questions Our Nurses are Brilliant! My GP prescribed Meloxicam but it had been approved by my Consultant for my knees following the damage from Chemo

Try the Team again on Monday to see what they say.

Hope it improves soon

Angela x

[PMRpro Ambassador in reply to Linny3]

Point out to them that the GP only writes the prescription - he can't initiate it and so doesn't know much about the drug and its side effects. Or the illness - that's why you were referred ...

[mgrogers99]

I doubt if it is a side effect. I've been on it for a long while and read the literature. If you were taking it orally any abdominal pain would make sense.

[Marijo1951]

I've been taking MTX orally since December 2017 and have never suffered the kind of pain you describe. I think you should persevere with the rheumy team, unresponsive as they are.

[Suet3942]

I have chostocondritis as well but never associated it with mx. It tends to come and go.

[Amkoffee]

There is something else that it could be. You may have pulled a muscle called the intercostal muscle. They hold the ribs together and allow the ribs to expand when you take in a breath. This can happen with nothing more than stretching when you wake up in the morning. The pain is intense and hurts to breath. I used ice and heat on the affected area. It lasted 3 months.

[Sirtomas]

I have rib pain on the right side. I have had this for 3 years since fell down a flight of stairs but it went completely when I was on +25 pred. Now that I am cutting the dose and am on 18 I find the pain is coming back again, I don't know if its a pulled muscle, PMR/GCA or a kidney problem. I'd like to speak to my GP but she's away on holiday for another two weeks. How does this compare with yours Linny

[Linny3 in reply to Sirtomas]

I did not injure myself. It just started getting sore and then got worse. It is Left side and high up in the muscle or rib cage. Hard to take a deep breath. I went to dr. 2 weeks ago and the erga- center and it was determined maybe a ligament. I have had ligament problems and they usually start to resolve within 2-3 weeks. This shows no sign of getting better. When I take a Tylenol and an Aleve, it feels some better, easier to breathe.

[Uglow]

I have awful pain around ribs Iv had a fractured vertebrae in 2018 Gp says this I take oxycodone and paracetamol to help. Not sure if it’s prednisone or what.

Gp

[karegodd]

I’m on mtx as well. Have terrible rib pain as well. Lower rib cage. Improves when I get moving but seizes up when I’m not moving. Thought it was a flare. Didn’t correlate it to the mtx. See my rheumi next week and plan to ask him.

[Linny3 in reply to karegodd]

good luck

[PMRnewbie2017]

I've had this too. Sometimes the breast bone, sometimes right or left side of the rib cage. Have noticed it comes on if I'm tapering too fast and beginning to over shoot my optimum dose. Then i would get other pmr symptoms. Now I've learned that for me this could be a warning of an impending flare. My pmr is well controlled but I sometimes push the taper a bit too enthusiastically. This has only become an issue for me below 5mg. I was diagnosed in 2017 and started on 30mg due to ??? GCA

[Blackcat1M]

Hi Lindy,I have been on mtx for a few years,and never had this,but I do get bruising from time to time, and on Tuesday when I took my mtx I had aching in my legs, but as I had been walking that day I was not sure if that was it.

[Linny3 in reply to Blackcat1M]

I get aching legs all the time. I think it is fibromyalgia.

[Buzybe]

Hi Linny3I was diagnosed with PMR last July and have been reducing since, with a couple of flares. The last one was when I was down to 4mg when I had neck pain and could hardly lift my head. I took 20mg for 3 days but that did not help the ache in my shoulder, arm and neck My GP then thought I had nerve damage and I payed to see a chiropractor who said I had good mobility in those areas so not nerve pain. My doctor then said he thought I had a virus and I told him about the sharp pain intermittently in my left rib, I was prescribed antibiotics for a virus . After seven days I still have aching shoulder, arm, neck and intermittent pain in rib., and am totally unsure what is wrong with me. Are these symptoms related to PMR.?

I cannot get a face to face appointment with my GP so I am going to ask for a referral to a rheumatologist to try and find out what is happening.

I have to advise that I am often woken up by these symptoms and consequently feeling tired.

Maybe I have Costochrondritis too.

[PMRpro Ambassador in reply to Buzybe]

You really have reduced the dose pretty quickly to be down to 4mg after a year. However - I'd be inclined to think the symptoms you mention are not directly due to PMR, which tends to be both sides, and yours aren't are they?

I think I'd be looking for a new GP - " I was prescribed antibiotics for a virus" abx don't do anything for viruses and GP are told repeatedly NOT to give abx for a virus, that is what increases the antibiotic resistance they talk about.

Did the chiropractor look at your back muscles or just the shoulder? A physiotherapist might provide more insight.

[Buzybe in reply to PMRpro]

Yes he did and did not find any nerve damage. Do you think seeing a consultant might help?

[PMRpro Ambassador in reply to Buzybe]

Wasn't nerve damage I was thinking of - more tight/spasmed muscles.

[Buzybe]

Yes he did and said he could not detect any nerve damage