Pros and Cons about methotrezate

[arvine]

been prescribed methtrexate by rheumy for painful what MRI s and exray few mos ago showed osteoarthris,back, hip, hands( now have been booked for hip replacement Feb 20/2025) still on 4 mgs prednisone, rheume says more chance of infection with surgery being on prednisone than methotrexate ? Orthopaedic surgeon doesnt agree, dosevstarting metho is 15 mgs 1st week, 17.5’mgs 2nd week, then bloodwork including hepitsitis check, Im reading all kinds of opinions, experiences on this sote about methotrexate and am very confused and worried about stsrting metho injections, my Wbc always flagged high and now red blood cells flagged at the bottom of normal, have fatty liver , and take med for bp, have to decide, suppose to start metho tomorrow, very stressed out snout it all,

[PMRpro Ambassador]

It won't replace the pred immediately - you have return of adrenal function to deal with first. But given your history, you probably need to try.

[arvine in reply to PMRpro]

Well do I need the appropiate tests for adrenal function to know if they are working, cortisol and synacthen test? I dont see endocrinologist until January, was planning on stsrting tapering again soon to 3 1/2 mgs of pred?

[arvine in reply to PMRpro]

I cant say Im fatigued only whencarrying out essential chores, frompain, do I get exhausted takes ot of energy when everyything hurts

[PMRpro Ambassador in reply to arvine]

Then maybe not - extreme fatigue is the usual effect of poor adrenal function. But what I meant was you can't stop the pred suddenly. You still have to taper off.

[arvine in reply to PMRpro]

Oh yes I know yhst. But thank you

[Heron82]

Everyone is different and it is very normal to be anxious when a new drug such as Mtx is suggested by health care professionals. However I hope my experience may provide you with some reassurance. I’ve been injecting 15 mg Mtx per week for over 2 yrs now, initially it was intended to be steroid sparing to help me reduce the steroid dose more quickly. I query whether this was the case, but it has helped with the osteoarthritis in my knees, wrists and hands ie pain is reduced and function improved. I have not experienced any side effects and the gastro side effects sometimes encountered with oral Mtx are avoided. I developed fatty liver after 8 yrs on pred.

I had complex foot surgeries whilst on 10 mg of pred with no issue. Both the rheumatologist and surgeon were not concerned about the dose or risk of infection from pred.. so 4 mg should not be an issue.

I hope your surgery goes well and that the lovely people on this site have helped to reassure you.

[PMRpro Ambassador in reply to Heron82]

Have you seen the work that shows it is useful in OA? I did post about it I think,

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

You did -have linked for Heron82

healthunlocked.com/pmrgcauk...

[arvine in reply to Heron82]

Thank you

[KASHMIRI1]

Sorry for late reply to your post, I am waiting for spinal surgery next year some time. I take methotrexate and pred. My rheumy said to stop methotrexate a week before op and two weeks afterwards.