Methotrexate Injection

[Fred]

Well this is it time to bite the bullet and go onto the poison Methotrxate, I didn't want to do this but I'm left with no option as Stelara has now failed on me. You can read my old threads about using Stelara here: Stelara 16 Months On. and Stelara round two I will still be keeping the latter one going as I'm still using Stelara, but I thought I would start a new one about Methotrexate.

If you look at some of my comments about methotrexate you will see I'm not a fan, but I'm stuck in a place at the moment where the psoriatic arthritis is taking over my life again and it's no fun. There are no other treatments available to me at the moment and even if there was I couldn't take them as I've just taken 90mg of Stelara, so I need something to try and slow down the onslaught of psoriatic arthritis.

Last time I tried methotrexate was around the mid 80s when living in the UK, the way you was treated for psoriatic arthritis in those days was appalling. I was told to take 8 methotrexate pills a week all in one go, they just kept on throwing them at my via repeat prescription and I can only remember having one blood test. After about six months of being as sick as a dog all the time with constant headaches and weird feelings going on that made me feel so grumpy I stopped taking it, I continued with loads of pain killers and ant-inflamatories for years until one day I was completely locked up and couldn't move.

By now I was living in France and was sent to hospital where they put me on the bio's and I got my life back, but now the bio's have failed. so as they know I'm against the use of methotrexate, we are trying a low does 5mg every week for 3 months to see if we can get the psoriatic arthritis down.

So this my journey:

I've had a blood test and all is well, so today the nurse came and made the first injection. I've also been told to take 5mg folic acid tomorrow (I'm not exactly sure what that does as I haven't researched it yet so maybe someone will now?) Friday the nurse will come back for another blood test. From there we are going with 5mg methotrexate every Monday, 5mg folic acid every Tuesday, and blood test every Friday for three months.

I will update as I go if there is anything to report.

Psoriasis Score: 9
Psoriatic Arthritis Score: 33
Feeling shit and miserable.

[Caroline]

Hoping for a quick result, that is the most important.

After that we will see further.

I am glad that there now is a very regular check for you.

[Fred]

Hoping for a quick result, that is the most important.

Yep that's my priority.

After that we will see further.

OK Nurse.

I am glad that there now is a very regular check for you.

I was a bit surprised every week for bloods as I had got used to every two months, just goes to show how much poison is in the stuff is.  

[D Foster]

Hi Fred a little info on Folic Acid which may be of interest, I was on 25mg of MTX by mouth and 20mg by injection so hopefully the dose you are taking will not effect you to much ,everyone is different so I hope that it will give you the results you want.

There is no definitive answer regarding the optimal dose of folic acid for patients with arthritis who are being treated with methotrexate.  It is generally agreed that folic acid supplementation reduces the toxicity of methotrexate without significantly affecting efficacy; although there seems to be a consensus of opinion that folic acid supplementation should be avoided on the day of methotrexate in case it adversely affects absorption.  Folic acid supplementation should be continued for the duration of methotrexate therapy because adverse effects can occur at any time.

There have not been any dose determining trials but regimens used in some of the studies include:

• 5mg folic acid taken the day after the methotrexate dose
• 1mg folic acid daily except on the day of methotrexate
• 5mg folic acid daily except on the day of methotrexate

It is considered that the folic acid dose should be high enough to prevent folate deficiency.  Many reviewers have extrapolated the data from the studies and recommend using 5mg folic acid weekly.  Some administer this dose the day after the methotrexate dose and others suggest that a dose taken 48 hours prior to the methotrexate dose may give added protection against the gastrointestinal adverse effects.  The dose can be increased to 10mg if the patient experiences any adverse effects to the methotrexate.  

The British Society for Rheumatology guidelines for disease modifying anti-rheumatic drug therapy recommends a typical folic acid dose of 5mg once weekly, preferably the day after the methotrexate.  They state that folic acid can be given any day as long as it is not on the same day as methotrexate.  Folic acid reduces toxic effects and improves continuation of therapy and compliance.
When I first started taking MTX I had blood tests every week for the first month, two week intervals the next month and then every month . I continued monthly for the first year then every three months with extra ones when I went to the clinic .
Dave

[Fred]

Hi Fred a little info on Folic Acid which may be of interest, I was on 25mg of MTX by mouth and 20mg by injection so hopefully the dose you are taking will not effect you to much ,everyone is different so I hope that it will give you the results you want.

There is no definitive answer regarding the optimal dose of folic acid for patients with arthritis who are being treated with methotrexate.  It is generally agreed that folic acid supplementation reduces the toxicity of methotrexate without significantly affecting efficacy; although there seems to be a consensus of opinion that folic acid supplementation should be avoided on the day of methotrexate in case it adversely affects absorption.  Folic acid supplementation should be continued for the duration of methotrexate therapy because adverse effects can occur at any time.

There have not been any dose determining trials but regimens used in some of the studies include:

• 5mg folic acid taken the day after the methotrexate dose
• 1mg folic acid daily except on the day of methotrexate
• 5mg folic acid daily except on the day of methotrexate

It is considered that the folic acid dose should be high enough to prevent folate deficiency.  Many reviewers have extrapolated the data from the studies and recommend using 5mg folic acid weekly.  Some administer this dose the day after the methotrexate dose and others suggest that a dose taken 48 hours prior to the methotrexate dose may give added protection against the gastrointestinal adverse effects.  The dose can be increased to 10mg if the patient experiences any adverse effects to the methotrexate.  

The British Society for Rheumatology guidelines for disease modifying anti-rheumatic drug therapy recommends a typical folic acid dose of 5mg once weekly, preferably the day after the methotrexate.  They state that folic acid can be given any day as long as it is not on the same day as methotrexate.  Folic acid reduces toxic effects and improves continuation of therapy and compliance.

Dave

Thank you Dave that's very helpful, I hadn't looked into it much as I didn't want to put my self off taking it. I hate pills of any kind, but knowing they help with the toxic effects gives some piece of mind.

[jiml]

When I was on 10 little pills of methotrexate I took them on a Monday and a 5mg folic acid tablet on the Friday .... Agree with Dave it's so your folate levels don't fall... But I have no idea what the levels should be

[D Foster]

A study investigating folate levels in methotrexate patients with rheumatoid arthritis concluded that there is a close relationship between folate status and side-effects during methotrexate therapy and that only a minority of side-effects are reported when concomitantly measured Red Cell Folate levels are above 600 – 800 nmol/l

Raised levels of homocysteine are associated with coronary heart disease and stroke . Homocysteine levels are frequently elevated in rheumatoid arthritis patients and low dose methotrexate treatment may increase them further . Folic acid supplementation lowers the prevalence of chronic hyperhomocysteinemia .

A little bit more info Fred.

[Fred]

When I was on 10 little pills of methotrexate I took them on a Monday and a 5mg folic acid tablet on the Friday .... Agree with Dave it's so your folate levels don't  fall... But I have no idea what the levels should be

When I was on them in the UK they never gave me any folic, and they wondered why I stopped going to my dermatology appointments.  

A study investigating folate levels in methotrexate patients with rheumatoid arthritis concluded that there is a close relationship between folate status and side-effects during methotrexate therapy and that only a minority of side-effects are reported when concomitantly measured Red Cell Folate levels are above 600 – 800 nmol/l

Raised levels of homocysteine are associated with coronary heart disease and stroke .  Homocysteine levels are frequently elevated in rheumatoid arthritis patients and low dose methotrexate treatment may increase them further .  Folic acid supplementation lowers the prevalence of chronic hyperhomocysteinemia .  

A little bit more info Fred.

Not sure if it's good info for me though Dave.

I knew I hated this bloody stuff, so not only does it poison me, it can also cause my ticker to go wonky.  

[Caroline]

I knew I hated this bloody stuff, so not only does it poison me, it can also cause my ticker to go wonky.  

That seems to be a risk of PsA anyway. The so called co-morbidity.
It was mentioned somewhere in one of the publications you have referred to.

[Fred]

I knew I hated this bloody stuff, so not only does it poison me, it can also cause my ticker to go wonky.  

That seems to be a risk of PsA anyway. The so called co-morbidity.
It was mentioned somewhere in one of the publications you have referred to.

Yes I remember posting it somewhere, but I enjoy finding fault with methotrexate anyway.