stopped taking MTX

[ipnotica]

Hi everyone!

My husband was prescribed MTX by his rheumy, but he was reluctant to take it. With a little coaxing, he finally decided to give it a try. He took 6 pills a week, all at once, for 4 weeks, and folic acid every day.

He hated the MTX because it made him really tired and he felt sick for a couple of days afterward, but he saw immediate and remarkable improvement. The swelling in his joints was almost completely gone and he never complained about being stiff or sore. The way he was able to move so freely, he was like a different person!

When he finished the last dose he told me not to have it refilled because he had decided that he wasn't going to take it any more. Right about this time, his doctor's office called to reschedule his appointment, and I told them that he didn't like the MTX and probably wasn't going to continue taking it. They told me to have him cut down to 3 pills a week. I passed this info on to my husband, but he'd already made up his mind that he was done with it.

So, he's been off the MTX for about 2-3 weeks now, and he's so stiff and sore that he can hardly move. The PA is back in all the usual joints, and some new ones, too. His jaw is hurting so badly now that he can't even eat, and I'm sure this is from PA.

I know he doesn't want to start taking the MTX again, but he can't go on like this. His doctor also mentioned Humira, but for some reason wanted him to take the MTX first. What I want to know is, will lowering the dose of MTX from 6 pills to 3 keep him from feeling sick, but still have the same effect on the PA? And why start with MTX and then switch to Humira? Does Humira work better if you take MTX first?

Thanks for any advice you can give me.

[deemah]

Hi Ipnotica

Some insurance companies require that a patient try systemic meds like MTX or Soriatane before using biologics like Humira. Perhaps that is why your husband's derm started him out with MTX.

[BrianV]

In addition to what Deemah said, MTX is a lot cheaper than Humira and many insurance companies want to see if that works first.

Is it just the tiredness/sickness that's causing your husband to not take the MTX? If so, would he be willing take it in injectable form? Some people on this forum have reported that helps out on the felling sick part.

[ipnotica]

Thanks deemah and Brian! That makes sense ~ I bet that's probably why.

Brian, it's the tiredness and the feeling sick, but it's also the not being able to have a beer if he wants one! I think he would more readily do the injectable if it lessened the side effects. But I think if he's going to do the injectable he'd rather try Humira ~ probably because he thinks it's ok to drink a beer while on Humira ;)

I guess he's just going to have to choose between the lesser of the evils. Thanks again!

[JesseLou]

MTX works in a different way than the biologics do, and when it does the job - as it did really well with your husband - it doesn't suddenly stop working like the biologics have a tendency to do.

The side effects of MTX do go away, but the effects of PA only get worse when untreated. So, if MTX is really intolerable for him, get him on another treatment before he loses the ability to function. It's that important.

[wregle]

Please tell your husband to give it another try. I have been on it for several years and after the first month or so the side effects diminished greatly. I am tired the next day but only for a few hours. I have a small stomach issue 1st thing in the AM but that is the only time. I take mine early evening and am able to sleep through the gastro problems. I take mine on Sunday night because I hate Mondays anyway. I used to take it on Friday night because I could lay low on the weekend if I needed to. I take 4 a week. Used to take 5 but had an elevated LFT so they took me off for a while. I started having a lot of pain again and asked to go back on. He started me at 3 and then I got him to up it to 4. I had thinning of the hair also but that settled down quickly. One of the side effects is "sudden rapid weight loss" - but of course I never got that one!! As far as the beer goes - I will still have a glass of wine and a lot more than that on vacation but I don't drink the day before, the day of or the day after by MTX. This has seemed to work well for me. Also, after a night of partying or being on vacation - don't schedule your blood work!

[SWinNYC]

I have taken MTX both ways (oral and IM). I really prefer the IM route because it definitely cuts down on the side effects. I don't get nauseous and the effect on my PA has been fantastic. I know it's kind of a scary drug, but if your husband is in that much pain it sounds like he should go back on.

[ipnotica]

Thanks, everyone, for all your help! My husband decided the joint pain was worse than the MTX, so he started taking it again. He's taking 3 instead of 6 now, so I hope it works as well as it did before. Fingers crossed!

Thanks again :D