Starting Methotroxate

I've read quite a bit about Methotroxate. I also see a lot of side affects. Not too happy about that at all. I picked up my prescription but kind of apprehensive about starting it. I will think about it I guess. I did google it after I picked it up. Humm....

I think the apprehension is probably the biggest obstacle to overcome. If you have it, try it. Many people have no side effects, it may help you. The only way to know is to have tried it. If it makes you feel unwell you can stop and then you have some grounds for discussion with the rheumy - because some have been known to throw their toys out of the pram when a patient has said no without good grounds.

You say he will see you in June unless you have issues - he has arranged for the appropriate blood tests to monitor you I hope? Liver function tests are particularly important, together with a full blood count, urea and electrolytes and urinary protein and blood. They should have been done before starting the tablets too. They are important to avoid some of the potential side effects.

And you do have folic acid to take on the other days? They are also important to avoid some of the side effects, particularly the mouth ulcers.

https://patient.info/medicine/methotrexate-maxtrex-metoject

 

I did not have a liver function, test but had a full blood count in Nov for my 2 surgeries. Plus, he took more blood work this week before he prescribed Methotroxate. I have yearly endoscopes for my liver and pancreas.

Had the last in Sept 2015.

I'll give it serious consideration. Thank you.

A liver function test amongst others before MTX therapy in RA (and PMR is little different) is regarded as mandatory by most experts and are certainly done by most doctors:

"...The investigations that are mandatory before starting methotrexate therapy in a patient with RA consist of a full blood cell count, serum transaminase levels, serum creatinine with computation of creatinine clearance, and a chest radiograph. In addition, serological tests for the hepatitis viruses B and C and a serum albumin assay are recommended. In patients with a history of respiratory disease or current respiratory symptoms, lung function tests with determination of the diffusing capacity for carbon monoxide are recommended; 6: Investigations that are mandatory for monitoring methotrexate therapy in patients with RA consist of full blood cell counts and serum transaminase and creatinine assays. These tests should be obtained at least once a month for the first 3 months then every 4-12 weeks; 7: Folate supplementation can be given routinely to patients treated with methotrexate for RA. In practice, a minimal dosage of 5 mg of folic acid once a week, at a distance from the methotrexate dose, is appropriate..."

Personally I wouldn't take it until they'd been done - they are hardly difficult or expensive. It is possible they did them in November but that should be checked and the monitoring ones need to be sorted out.

Gosh, I hate to ask... But since you mentioned the folic acid...

Went to Rheumy Monday. I had blood tests done here in my small town verses the more well known blood labs. 

The liver/kidney tests said "chronic kidney disease stage" 

This has not been flagged before. At first liver was flagged, but I stopped drinking for most part. Liver levels went back to normal. This over last 7-8 months. This is why Sulfasalazine vs the methotrexate.

I looked at my copies of labs I have and saw numbers are same, (bun 21, eGFR 65) but one lab said it now uses a different calculation. I'm thinking my small town hospital is using an older calculation.

Anyway... The PA (at my Rheumy) prescribed Leucovorin Calcium (folic acid?) 5 mg once week as you mentioned above. 

I'm trying to research it, I'm on Sulfasalazine vs. Methotrexate.

I feel I don't have symptoms of low folic acid I see listed, I eat greens, mushrooms, eggs weekly. Should I trust this medication too?

Her comment was something like "is it the Plaquenil, the Sulfasalazine?" Like she didn't know. Just said we will retest in April. 

Ugh, more meds... Should I or shouldn't I? 

No reason not to take it - it's commonly given to women wanting to conceive. It's just like any other supplement and might improve your hair   Sulphasalazine can cause the deficiency too so it is probably that - the drugs interfere with some enzyme or other (off the top of my head) so you simply need more to avoid developing it. 

Your eGFR is CKD stage 2 which is pretty much normal for people of our age. There was fury amongst specialists when it was added to the standard reports - nurses and some GPs don't get it and so patients are told they have "kidney disease" when they absolutely don't - but of course they then worry big time. 

Thanks so much!! Could use hair improving!!!  

 

There you are then!

It occurred to me afterwards - I should have asked what you would have said if she had said take extra vit C????????????

Thank you, thank you, thank you......i had the same thing happen

when regular blood tests taken....scary to see results say

"chronic kidney disease"  My doc went over it with me and

wasn't concerned at all.  Glad to get another take on

the results.....my doc kept saying "for your age"  and

don't we love to hear that?

Layne, worry not about being labelled with CKD Stage 2 - as Eileen has said a reading of eGFR 65 applies to most of the generation over a certain age!  I have Stage 3 (eGFR 41) which unfortunately is continuing to deteriorate probably due to difficult-to-control high blood pressure and also to many of the drugs used to treat the high BP.  Into the bargain, I only have one kidney.  I was told by one consultant that the name Chronic Kidney Disease is unfortunate in his opinion but it was so named by the Americans and we have to live with it! 

When my friend discovered that her kidney function was reduced at eGFR 60, her GP followed up by saying that the Government had introduced a can of worms with this test in the hope of discovering whether reducing kidney function was either a disease process or simply an ageing process.  He said the result was 100's of panicking patients rushing off to renal consultants.

​I hope that puts your mind at rest at least as far as your kidney function is concerned.

Yes - I should have said that it is a figure they work out on the basis of other tests and they thought it would be a good way to get info about population statistics easily. The objection was it shouldn't be added to the results sent to the GPs but kept for specialists and records. 

and although MrsO's friend had a GP who understood, many don't and practice nurses are even less aware.

The figures assume 2 fully functioning kidneys - obviously only having 1 will reduce the volume that can be filtered and the figure falls even though the renal function is perfect. 

Thank you all for comments on the kidney thing. And clarifying my ignorance on the Leucovorin Calcium. I wasn't getting very far when researching.

They also wanted to start me on daily injections for the osteoporosis, but I'm not going to go there just yet. There is no osteoporosis in my family and being an ex-runner I'm surprised.  Might have been since I was taking the calcium at same time as the Prednisone but not sure that would have caused osteoporosis that quick??? 

At 54, I'm going to make the most of my life with this temporary setback and lessons.

Just weird going from only taking low dose thyroid pill, the only pill I've ever needed (and that's questionable) and now all these others.  

So like many of us, we try to keep it at a minimum. Glad we are smart and look out for each other! 

I've never needed pills for a chrinic condition until pred.  BTW you should, if you haven't already, have that thyroid med assessed as apparently pred can affect dosage required.  If you start to have untoward symptoms it may be because the thyroid med needs adjustment.