Methotrexate please help

[fialstar]

I have a question....
I have done numerous searches online but can't seem to find an answer....

I have been on oral mtx for over a year, and I am finding that my finger joints are becoming inflamed and distorted (mostly over the past 6 months or so.) I am also beginning to get skin plaques again after being completely clear for over 10 years.
How long is long enough to know for sure that the dose/medication is not working?

I have an appt with my new rheumy coming up, and I want to get off mtx due to side effects and my belief it isn't working for me but my gp, dermy and rheumy keep urging me to stay on it. Why, when I am obviously haging issues?

So far, I have found online sites saying 3 months, 6 months, one year and 3 years are all acceptable time frames.
Very confusing!

I cannot find an Australian site that gives clear information. How am I supposed to advocate for myself if I don't have the info?

Please help.

[jiml]

I would say if youre on mtx for a year and you are not improving or even getting worse then it's time to change
You don't say what dose you have been on but for me it was 25mg to get me clear when I was on it ..

The reason your doctor wants you to stay on methotrexate is probably because it's so cheap and anything else will cost them more so the longer they make you suffer the more money they are saving

For me I would request something else as you've given it more than a fair try

[Caroline]

Dutch psoriasis organisation says:
- it takes a few weeks before MTX starts working.
- after 2 to 3 months the maximum working point will be reached.

These guidelines are backed by the organisation of dermatologists in the Netherlands.

So.... you are on 6 months and still have or getting problems..... what do you think knowing above?
At least I would quit the stuff, it has no use going on.
And if possible try to switch to DMF after a bit of time recovering from the MTX.

Oh, sorry, you are from Australia, then you can’t switch to DMF as that is not in the package of Dermatologie over with you.
You could try another systemic, but if I were you I would try to get a bio, preferably Cosentyx.

[Raxyl]

Hi Fialstar, I agree with Caroline. If I were you I'd talk to your Derm/Rhem and raise the possibility of working towards a Bio like Cosentyx. I don't believe there is a specific timeframe guide as to the failure of MTX but what you have described sure sounds like it's no longer working. As elsewhere here in Australia we have to work through a number of other treatments including; Topicals, UVB, Acitretin and Methotrexate before you can be approved by Medicare for a Bio. Good luck and make sure to let us know how you go.

[Fred]

I'm sorry as I can not help when it comes to methotrexate. But I have changed your Thread Subject in the hope it will get you more answers.

We do have many threads about methotrexate, but this is all that is available that I have been able to find Methotrexate and I try to keep it updated.

I have my views, but that is not in relation to you question so I will keep my views to myself in this thread.

[Kat]

Afraid I can't really help either. But I wanted to say hello!

I would stress with your doctors that it is not working for you. Lots of times, doctors have a certain protocol when it comes to medications that insurance requires (Raxyl gave you info on how it works for Australia, which is similar to most places I think) but I would think that if it's not working they could move forward!

I would think that you could advocate for yourself simply by your symptoms. They can see the plaques and should see the inflammation and distortion of your joints. That's what I personally would use for proof that it's not working!

Best of luck

[Raxyl]

Afraid I can't really help either.  But I wanted to say hello!

I would stress with your doctors that it is not working for you.   Lots of times, doctors have a certain protocol when it comes to medications that insurance requires (Raxyl gave you info on how it works for Australia, which is similar to most places I think) but I would think that if it's not working they could move forward!  

I would think that you could advocate for yourself simply by your symptoms.  They can see the plaques and should see the inflammation and distortion of your joints.  That's what I personally would use for proof that it's not working!

Best of luck

[JohnB]

I can't add much more than the rest have mentioned
That said I am into the early stages of MTX, currently on 10mg and getting steady clearance without any side effects. I have a red line I won't cross and that is to increase this dose, so when it shows signs of failing or the side effects kick in to where they need medication the I will be asking for the next medication. To me 12 months is more than long enough.
JohnB

[fialstar]

Thankyou so much for your responses.
I still don't really know the guidelines for Australia, but I am heartened by your responses and determined to stand up for my health at my April 30 appointment!

[jiml]

Thankyou so much for your responses.
I still don't really know the guidelines for Australia, but I am heartened by your responses and determined to stand up for my health at my April 30 appointment!

Yes you really should let them know that you know there are other things you could and should be on by now tell them you have suffered enough

Tell them it's affecting your mental wellbeing and you can't go on feeling as bad as you do   they should take note and hopefully change you to something else
Read the different treatments in the prescribed Prescribed Treatments For Psoriasis then you can talk with a degree of knowledge about what's available and can have a meaningful discussion with your dermatologist about your options