Methotrexate - information needed

[Yorksman]

The report from my rheumatologist to my GP (which I've yet to discuss) suggests using 'disease modifying drugs' which I assume means Methotrexate. There is a lot on the forum about Methotrexate but what exactly is it, how does it work and what are the pros and cons? Presumably it replaces Prednisolone.

[PMRpro Ambassador]

It is a DMARD - in RA, It is an immunosuppressant. It is a cytotoxic drug - it damages fast replicating cells and in high doses it is used in chemotherapy in cancer. However it has also been found to modify the disease process in RA at low doses which do have far fewer adverse affects and since the 1980s has been the first line medication for RA. But even so, it still can have very risky side effects in some patients and regular monitoring of blood tests is essential and so is strict adherence to the once WEEKLY dosing. And drug interactions can be very dangerous if ignored.

As a DMARD, it actually has an effect on the disease process: in RA, stopping the damage to the joints, but not in PMR where there is no joint damage to prevent. How it works in PMR, if it works, is unknown. I personally do not think adding another immunosuppressant to pred is justified unless it is guaranteed to get you off pred - and top immunologists are also concerned about the long term additive effect on the immune system.

No, it DOESN'T replace pred for the majority of patients. It is claimed to potentiate the effect of pred and to suppress the immune system meaning you get more bang for your buck from the pred and hopefully manage on a lower dose. There are no guarantees however. It does work very well for a small cohort of patients but there is no way of knowing if you are one without actually trying it. If it were that good they would use it rather than pred for PMR - they don't. And according to Prof Dasgupta, the UK GCA guru, it has no role to play in GCA at all. Prof Mackie in Leeds is about to start a trial to assess its use in PMR - currently her opinion is that it works brilliantly for SOME patients, but by no means all.

It has its own adverse effects - you can read all about those in existing discussions. After barely a month on it I was unable to function because of overwhelming fatigue - made PMR fatigue look nothing. I gained weight, it created so-called pred effects I had never had on pred and overall I felt worse than I had in 5 years of untreated PMR! My hair fell out in clumps - not just thinning. I didn't suffer nausea - but that was the only positive! It seemed to make my arrythmia worse - causing worse bradycardia episodes. That never improved again and eventually I needed a pacemaker.

But not everyone has problems and it DOES work for some - you don't know until you try. If you have no or mild adverse effects it is worth a try.

[SheffieldJane in reply to PMRpro]

Very helpful to see this all in one place. Thank you!

Obviously there is Mrs Nails’ input in FAQs too.

[Yorksman in reply to PMRpro]

Thanks, very helpful. Good to be well informed.

[Korkycat123]

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