Methotrexate

[Guest guest]

Dear Caro:

I read your letter. You have to make up your own mind. You can't let

Doctors force you to do something that you don't want. Metho is a strong

drug. It is not for everyone. It can be a risk. A lot of things can be

too. I can't take Metho, because I have a kidney transplant and Docs told me

it would ruin the kidney and kill me. I took some immuran for a while, but I

am off it now. I take prednisone. Which isn't a terrific med either because

it has some side effects, but is better for me than Metho or any of the other

new meds that my Doctors don't recommend either for me. I also use pain

medicine. Are you using any pain medicine? Hope to hear from you.

Sincerely,

Anjillah@...

[Guest guest]

Caro:

I have to agree with a. You need to get on a DMARD asap or the RA could

do much more damage (even kill you) than the drugs ever could. I have been

on MTX for quite some time now. I am very fortunate because it has put me

into remission as it did my father. In fact my father has been completely

off meds now for two years. This is because of early intervention. I have

had elevated liver enzymes etc. but I take Milk Thistle to help that. It is

suppose to help your liver and seems to help mine. Truly you have more to

fear by not using medication than by the side effects of the medication.

Good Luck.

Sincerely, Jeannette

[Guest guest]

Caro,

I also agree with everyone else here. You need to be on some kind of DMARD

be it mtx or something else i. e. Enbrel, Arava, and there are a lot of

others out there.

When I was first dx'd I also refused to take mtx. By the time I agreed to go

on it I was at the point of needing a wheel chair. I was 35 yrs old and had

a 4 month old baby. This more than anything made up my mind for me. For me

it made me mobile again. It took about 4 to 6 weeks to work and we had to

keep increasing the dose, but it did work for me for 2 years, then it just

stopped working.

I've been on Arava and Enbrel (and a few others) and nothing is working for

me, so right now I'm back on mtx. I don't feel that it is working this time

for me, but who knows, without it I could be a lot worse off. I am currently

trying to get into a clinical trial, if not then I'm going to try Remicade

next.

All of these drugs are very scary, but so are the side affects of RA left

untreated. I had a coworker who last year lost his mother (she was 54) due

to RA, she refused to take any RA medications. This really hit home with me.

I also am a strong believer in pain meds, I use them daily, without them I

wouldn't be able to function. If you choose not to take mtx then please

consider one of the other DMARDS. Make sure you talk to your RD and tell

him/her about your fears and concerns. Welcome. Tery

[Guest guest]

I had a friend who took Metho for her RA. and along with it she had

to take pills for her liver and such to counteract what the metho did

to her body. My doctors are now wanting to put me on Metho and I am

scared to death. My friend died 2yrs ago. From her stomach being

basically eaten out. I don't want the same fate. Isn't there anything

else that is not so hard on the body? I know I need ra meds. But the

effects of them just scares me really bad. I've put off ra meds as

long as I can. But the doctors are really pushing it now. It seems

the ra has moved into my jaw joints. As well as most of my other

joints. I figured if anyone would know if there was a safer medicine

then meth for ra you all would. Can you help me? Thanks.

Caro~

>

> AMERICAN COLLEGE OF RHEUMATOLOGY

> POSITION STATEMENT

>

>

> SUBJECT: Methotrexate

>

>

> PRESENTED BY: Neal S. Birnbaum, MD, Chairman, Council on

Rheumatologic Care

>

>

> FOR DISTRIBUTION TO: Members of the American College of

Rheumatology, People with Arthritis, Primary Care Physicians, Medical

Societies, Media Representatives

>

> BACKGROUND:

>

> Methotrexate is used in the treatment of certain neoplastic

diseases, severe psoriasis, and psoriatic arthritis, and has been

approved by the Food and Drug Administration for use in the treatment

of severe rheumatoid arthritis. For more than twenty years, the drug

has been the subject of clinical trails in people with rheumatoid

arthritis and has proven to be beneficial in both short- and long-

term management of recalcitrant forms of the disease.

>

> As an antirheumatic drug, methotrexate is used as a second-line

treatment for rheumatoid arthritis. It is also used by

rheumatologists under certain circumstances for other severe

rheumatic diseases. It is not ordinarily prescribed until other forms

of anti-inflammatory treatment have been prescribed. It should only

be prescribed by physicians who are experienced in initiating and

monitoring such antirheumatic therapy. The drug is not appropriate

therapy for all people with rheumatoid arthritis.

>

> Methotrexate works by inhibiting the production of the enzyme,

dihydrofolate reductase, which is necessary for the metabolism of

actively dividing cells, such as those involved in inflammation and

the immune response. The exact mechanism of the action of

methotrexate in rheumatoid arthritis is not clear.

>

> Clinical studies with methotrexate have demonstrated that people

who take the drug have less joint pain and swelling, reduced morning

stiffness and less fatigue.

>

> Improvement usually occurs between three and six weeks after

treatment is initiated. Methotrexate is taken once a week in a single

or divided dose; it can be taken by mouth or given by injection. The

dosage may be adjusted -- which averages between 7.5 and 15 mg. per

week -- depending on individual response.

>

> The most common side effects of methotrexate include loss of

appetite, nausea, diarrhea, sores or ulcers in the mouth, decrease in

platelets, or white and red blood cell counts. Potential for liver

toxicity exists, specifically in people with preexisting liver

disease or who are heavy users of alcohol. Rare but serious side

effects include fibrosis and cirrhosis of the liver, bone marrow

suppression, and a reaction similar to pneumonia, usually indicated

by fever, cough and severe shortness of breath.

>

> Blood tests should be conducted to detect potential bone marrow and

liver problems. Liver biopsies may be indicated prior to initiating

therapy or during the course of therapy to determine if fibrosis of

the liver is present. Further investigations into the need for, and

frequency of, liver biopsies for people taking methotrexate are

ongoing.

>

> Pregnant women should not take methotrexate because it is known to

cause birth defects, miscarriages, and stillbirths. Pregnancy should

be avoided if either partner is taking the drug during and for a

minimum of three months after therapy for men and during and for at

least one ovulatory cycle after therapy for women.

>

> POSITION:

>

> 1. Methotrexate is a relatively safe and effective treatment for

rheumatoid arthritis and other autoimmune diseases. Individuals who

believe they are candidates for methotrexate treatment should contact

their family physicians or rheumatologists.

>

> 2. Only physicians, such as rheumatologists, who are experienced in

treating rheumatoid arthritis and who are fully aware of its

potential toxicity, should prescribe methotrexate.

>

> 3. Careful monitoring and patient education are essential to reduce

the potential for side effects of methotrexate, which include nausea,

diarrhea, loss of appetite, suppression of blood cell production,

inflammation of the lungs and liver damage. Appropriate monitoring of

a patient taking methotrexate may include a baseline chest x-ray and

periodic determination of WBC, RBC, platelets, and liver function

studies.

> http://www.rheumatology.org/position/methotrexate.html

>

>

>

>

[Guest guest]

Caro,

MTX is one of the best RA medicine available. Studies show that it works

best in combination with other drugs. MTX and Enbrel, MTX and Remicade,

both are very effective combos. Your doctors are pressuring you because

your joints are eroding, and they want to stop it. We are all afraid of the

side effects of these harsh drugs, but I am more afraid of what RA does.

I've already had both knees replaced at age 42, both ankles are eroded so

bad that I need replacements, and now my elbows are under attack even

thought I am on Enbrel. My doctor wants to start me on MTX, and I am

considering it. If I do, I will take injections so that I don't have the

stomach problems. I was on oral mtx many years ago and couldn't tolerate

the stomach side effects. Some people have no problems at all with it.

Please don't judge your treatment on someone else's. RA is a strange

disease, and every one of us reacts differently to the meds. That is why it

is so hard to treat. Early aggressive treatment is the best defense. There

are also meds that will help protect your stomach. Folic acid must be taken

with mtx, and that is probably what your friend was on. If you decide to

try mtx, make sure they do a chest x-ray first. If you have any lung side

effects, they can be caught quickly. I would definitely be more afraid of

RA than mtx, although I once felt like you. For many years I refused to

take RA meds because of the toxic side effects. I treated myself with

alternative medicine, and who knows if I did myself more damage. If you

can tolerate mtx, the doctors may add something else like Enbrel or

Remicade. I wish you luck with your decision. We've all been in your

shoes and know how hard it is.

a

----- Original Message -----

From: Caro <Caro@...>

< egroups>

Sent: Tuesday, July 18, 2000 9:51 AM

Subject: [ ] Re: Methotrexate

> I had a friend who took Metho for her RA. and along with it she had

> to take pills for her liver and such to counteract what the metho did

> to her body. My doctors are now wanting to put me on Metho and I am

> scared to death. My friend died 2yrs ago. From her stomach being

> basically eaten out. I don't want the same fate. Isn't there anything

> else that is not so hard on the body? I know I need ra meds. But the

> effects of them just scares me really bad. I've put off ra meds as

> long as I can. But the doctors are really pushing it now. It seems

> the ra has moved into my jaw joints. As well as most of my other

> joints. I figured if anyone would know if there was a safer medicine

> then meth for ra you all would. Can you help me? Thanks.

> Caro~

>

>

>

>

>

> >

> > AMERICAN COLLEGE OF RHEUMATOLOGY

> > POSITION STATEMENT

> >

> >

> > SUBJECT: Methotrexate

> >

> >

> > PRESENTED BY: Neal S. Birnbaum, MD, Chairman, Council on

> Rheumatologic Care

> >

> >

> > FOR DISTRIBUTION TO: Members of the American College of

> Rheumatology, People with Arthritis, Primary Care Physicians, Medical

> Societies, Media Representatives

> >

> > BACKGROUND:

> >

> > Methotrexate is used in the treatment of certain neoplastic

> diseases, severe psoriasis, and psoriatic arthritis, and has been

> approved by the Food and Drug Administration for use in the treatment

> of severe rheumatoid arthritis. For more than twenty years, the drug

> has been the subject of clinical trails in people with rheumatoid

> arthritis and has proven to be beneficial in both short- and long-

> term management of recalcitrant forms of the disease.

> >

> > As an antirheumatic drug, methotrexate is used as a second-line

> treatment for rheumatoid arthritis. It is also used by

> rheumatologists under certain circumstances for other severe

> rheumatic diseases. It is not ordinarily prescribed until other forms

> of anti-inflammatory treatment have been prescribed. It should only

> be prescribed by physicians who are experienced in initiating and

> monitoring such antirheumatic therapy. The drug is not appropriate

> therapy for all people with rheumatoid arthritis.

> >

> > Methotrexate works by inhibiting the production of the enzyme,

> dihydrofolate reductase, which is necessary for the metabolism of

> actively dividing cells, such as those involved in inflammation and

> the immune response. The exact mechanism of the action of

> methotrexate in rheumatoid arthritis is not clear.

> >

> > Clinical studies with methotrexate have demonstrated that people

> who take the drug have less joint pain and swelling, reduced morning

> stiffness and less fatigue.

> >

> > Improvement usually occurs between three and six weeks after

> treatment is initiated. Methotrexate is taken once a week in a single

> or divided dose; it can be taken by mouth or given by injection. The

> dosage may be adjusted -- which averages between 7.5 and 15 mg. per

> week -- depending on individual response.

> >

> > The most common side effects of methotrexate include loss of

> appetite, nausea, diarrhea, sores or ulcers in the mouth, decrease in

> platelets, or white and red blood cell counts. Potential for liver

> toxicity exists, specifically in people with preexisting liver

> disease or who are heavy users of alcohol. Rare but serious side

> effects include fibrosis and cirrhosis of the liver, bone marrow

> suppression, and a reaction similar to pneumonia, usually indicated

> by fever, cough and severe shortness of breath.

> >

> > Blood tests should be conducted to detect potential bone marrow and

> liver problems. Liver biopsies may be indicated prior to initiating

> therapy or during the course of therapy to determine if fibrosis of

> the liver is present. Further investigations into the need for, and

> frequency of, liver biopsies for people taking methotrexate are

> ongoing.

> >

> > Pregnant women should not take methotrexate because it is known to

> cause birth defects, miscarriages, and stillbirths. Pregnancy should

> be avoided if either partner is taking the drug during and for a

> minimum of three months after therapy for men and during and for at

> least one ovulatory cycle after therapy for women.

> >

> > POSITION:

> >

> > 1. Methotrexate is a relatively safe and effective treatment for

> rheumatoid arthritis and other autoimmune diseases. Individuals who

> believe they are candidates for methotrexate treatment should contact

> their family physicians or rheumatologists.

> >

> > 2. Only physicians, such as rheumatologists, who are experienced in

> treating rheumatoid arthritis and who are fully aware of its

> potential toxicity, should prescribe methotrexate.

> >

> > 3. Careful monitoring and patient education are essential to reduce

> the potential for side effects of methotrexate, which include nausea,

> diarrhea, loss of appetite, suppression of blood cell production,

> inflammation of the lungs and liver damage. Appropriate monitoring of

> a patient taking methotrexate may include a baseline chest x-ray and

> periodic determination of WBC, RBC, platelets, and liver function

> studies.

> > http://www.rheumatology.org/position/methotrexate.html

> >

> >

> >

> >

[Guest guest]

This is really great. At least I have a lot of info going in to a Rheumy.

My reg DR wanted to wait for the second line drugs until we could get a Rheumy

on the team. At least it won't all be mumbo jumbo to me.

Terry

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[Guest guest]

Hello. I think I posted to this group once before I went on vacation. I

am on MTX as well. Been on it for several years now. So far, so good. I

have blood drawn every month to check for liver involvement, but so far,

it's always been a clean bill of health that way. I haven't had any side

effects to it either and I take 8 tabs a week (I think that's like 20mg

or something).

Jenna

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[Guest guest]

I am familiar with somebody in Ireland taking methotrexate for cancer

and also on LDN with no problems. LDN should work fine with it as it

is not a narcotic.

All the Best

> Is anyone familiar with Methotrexate? I'm assuming that it would

not

> work well with LDN, but thought I's ask the group in case someone is

> using it. If anyone is using it, could you e-mail me regarding

your

> experiences. THANKS!

[Guest guest]

I went to see rheummy this week and got good news!!! Finally I am off Methotrexate. It has been a year of pure he!! on this medication and I am so glad to tell it goodbye!!!

I had lapband weight loss surgery 5 weeks ago. I had to come off all meds for surgery. It was so great to have no nausea, vomiting, diarrhea, mouth sores, eye sores and throat sores!!! I even had a 4 week remission of no symtoms while off all meds and recovering from surgery.

When I started my meds at 4 weeks post op I went back on Enbrel and Bextra. NO prednisone and no MTX. I just could not handle the side effects after having a med holiday.

I finally got my bone head doc to really listen to me. He is not a supportor of surgical weight loss. He did not believe me when I talked to him two months ago about I was being evaluated for surgery. Well he has changed his mind. I am 22 lbs thinner in 4 weeks and feeling great.

I also told him vomiting is totally out of questions since I jsut had surgery. We either needed to reduce the dose or stop the med completely. He agreed to 8 week trial of no MTX and no prednisone. He will monitor my lab values during this time and determine if I need more medication, If so we will try Arava and he is investigating adding Kinert.

Toni

[Guest guest]

I was on methotrexate but unfortunely my liver enzymes went sky

high. I am on humira once a week now.

>

> I take methotrexate once a week. I take a total of 12.5 mg

> weekly. I'm lucky that I've not had any side effects.

> I make sure that I eat some food before I take it.

>