Saw Physician wants me to start Methotrexate.
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I saw my Physician today. PMR still active CRP 15 was 25 in July. He wants me to start using Methotrexate 5mgms weekly. I am not happy but will give it a go as it may help my osteoarthritis. I asked him about the Actemra he didn't appear interested in giving it a go but also it is not on the free list here in Australia. I am taking 12.5mgms of Pred. He wants me to take the 12.5mgms for a week then reduce it down to 10mgms. Not going to happen! I don't see him till February so I will do the slow reduction as per the PMR protocol. I feel a bit ordinary, am over this PMR. Having a whinge sorry. I don't tolerate the prednisone if I take it in the mornings say 6am. I get a feeling of fullness in my head, I feel breathless, I have been taking it at 1am which seems to suit me better. I know from previous posts that the methotrexate does not help with PMR but I keep having flares on a regular basis and I think I am at the point where I will try anything. Open to any suggestions. Thanks Kath.
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EileenH Kassiebeetle
Posted
It may help the OA - but the evidence is not strong, the studies have been small. Medscape says
"Some small studies have shown promise for use of MTX in knee OA. Wenham and colleagues' open-label pilot study[8] evaluated 30 participants with OA who received MTX up to 20 mg/week for 24 weeks; of those participants, 43% reported = 30% reduction in knee pain according to a visual analog scale.
More recently, Abou-Raya and colleagues[9] conducted a randomized, placebo-controlled study demonstrating a reduction in knee OA pain associated with the use of up to 25 mg/week of MTX for 28 weeks. They found a statistically significant mean difference between the treatment arms of 11.4% for the knee OA pain score on the visual analog scale. In addition, they found a reduction in synovitis (clinically and on ultrasonography) in the MTX group at 28 weeks.
Both of these studies show that MTX can reduce symptoms of pain in knee OA, which is encouraging, because this may indicate MTX may reduce inflammation associated with OA. However, the use of MTX does not come without adverse effects, ranging from mild (gastrointestinal disturbances, alopecia) to severe (hepatoxicity).[7] In addition, it is important to highlight that in both studies, the majority of participants (53%-88%) were taking concomitant NSAIDs, acetaminophen, or opioid medications in addition to MTX.[8,9]
Large, randomized, placebo-controlled trials with substantial efficacy and safety outcomes need to be published in order to strongly recommend the use of MTX for knee OA in clinical practice guidelines."
So I do hope your rheumy isn't trumpeting it as a certainty. But worth a try perhaps - providing it doesn't cause side effects.
If you are having flares on a regular basis - it is your body telling you that you have found the dose you are looking for: the lowest dose that manages the inflammation as well as the starting dose did. Force a further reduction and you will have a flare. And when you do that the impression I get across the forums is that you put yourself back. Proceed with caution and stop causing flares and you don't get into the yoyo pattern with dose - which inevitably leads to trouble.
amkoffee Kassiebeetle
Posted
I have one thing to mention. While you're on this, make sure your doctor is testing your liver enzymes on a regular basis. My doctor was and after a month of methotrexate my liver enzymes started to climb and they got fairly high. So we stopped the methotrexate and that was not enough I had to stop taking Percocet which I was taking for my back. Percocet has Tylenol in it and that hurts your liver too. Since stopping both of those my liver enzymes have gone back to the normal levels and no damage was done to my liver thank goodness.
judy93591 Kassiebeetle
Posted