stopping MTX

[girl_24]

Just a question........I have PA in one toe. It is painful and very swollen. I started off on 17.5 mg/week of MTX. I am now down to 10 mg/week. It is starting to swell back up on this dosage. MY P has not returned though on this dosage. I had awful P on my scalp and I do not want that to return.

The main thing that bothers me is the reduction in my immune system. I have a daughter in elementary school and I'm catching every virus she brings home. It just scares me to think how easily I could catch something more serious.

Now to my question....is there a drug out there that controls the symptoms of PA without having such a detrimental effect on the immune system?

[Cat13]

I don't think that there is, because arthritis is an immune system disorder. Your body is basically kicking it's own butt for no reason. So by supressing the immune system it calms the pain and swelling down. I don't think there will ever be a drug for arthiritis that doesn't supress it. Untill they find a way to do immune system transplants. HA, HA.

[arlcollins]

I like that, immune system transplant!!!

[girl_24]

One other question....does the amount of MTX you take effect the immune system as well? For example....does 20 mgs suppress your immune system more than 10 does?

[luvwinnie]

One other question....does the amount of MTX you take effect the immune system as well? For example....does 20 mgs suppress your immune system more than 10 does?

I believe so. ANyone know for sure?

[changzongli]

These are new drugs, anti-TNF (tumor necrosis factor) class. They are very expensive. MTX old, with pretty defined side effects. These newer drugs may have less effect on your immune system. TNF is a kind of mediator molecule in your body that contributes to your arthritis. You can try to search for the side effects of these newer ones on the internet. You may want to give it a try. Not guaranteed to have treamtment response from these.

[girl_24]

Is there anything else I could switch to that would not have the side effects, mostly the decreased immune system? That just scares me!!

[chaimFL]

Is there anything else I could switch to that would not have the side effects, mostly the decreased immune system? That just scares me!!


I don't think there is anything you can switch to that will slow or stop the progression of the disease that does not compromise your immune system to some extent. You can switch to NSAIDs, but I wouldn't suggest that as a great idea.

[girl_24]

How frustrating is this? You either are in a lot of pain and have swelling, P, etc. or you are putting your health in danger by taking these meds. Sounds like we can't win!!

[chaimFL]

I like that, immune system transplant!!!


Interestingly this is not impossible, believe it or not. Another shock is that there actually is a possible to cure to psoriasis (I don't know if the same would apply for psoriatic arthritis).

Ok, so now that everyone thinks I've lost my mind I shall explain.

A bone marrow transplant is as close to an immune system transplant that we have or may ever have. There are reports of people that required bone marrow transplants, who happen to have have psoriasis, and were cured of their psoriasis.

The transplant is risky at best and not suggested as a treatment for just psoriasis or psoriatic arthritis. Even if you thought it was worth the risk I would doubt you could find a doctor willing to do the procedure just for this reason.

Just to let everyone know that I am not making this up and that I didn't hit my head to hard this morning the clinical data is here:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12221673&query_hl=2&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8683865&query_hl=2&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9506573&query_hl=2&itool=pubmed_docsum

And the reverse scenario is applicable:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9274640&query_hl=2&itool=pubmed_docsum

And here is why the risk is so great:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11149740&query_hl=2&itool=pubmed_docsum

[chaimFL]

How frustrating is this? You either are in a lot of pain and have swelling, P, etc. or you are putting your health in danger by taking these meds. Sounds like we can't win!!

It's very frustrating to have a disease that involves the immune system.

I happen to agree with changzongli that biologic treatments are some of the best around. They only involve a very specific part of the immune function and generally speaking don't make people more susceptible to illness.

There are pleny of people out there who can report on infection hell after using biologics, but those people are the minority by a huge margin. Many of those people have weakened immune systems from other conditions as well that further complicates the use of biologics.

I was on enbrel for just under 6 months and it worked wonders on my mild PA, but did nothing for my skin involvement so I discontinued. I noticed no difference in my health or amout of infections I got. I have two children ages 4 and 22 months and I work in an office with 400 people in our company, but never got sick. Of course, this is just my experience.

[sonchi]

biologics target TNF-alpha. while MTX, I believe, supress the immune system in general. The immune system is a very complex system. the anti-viral mechanism inhibition from biologics may not be affected as much as MTX would do for you.

it is sad that many times we have to risk side effects to treat ourselves.