Methotrexate & Recurrent Chest Infections

[bmcbeth]

Hi everyone

I am 46, asthmatic and have psoriatic arthritis.  I use Seretide & Montelukast regularly for asthma and salbutamol when required.  I was on combined sulfasalazine and methotrexate last year for arthitis but after 8 chest infections the sulfasalazine was stopped mid November as I was told that the combined effects of the two drugs can make you particularly prone to chest infections.  I have now come down with another chest infection and am on antibiotics and steroids.  As an added bonus any infection like this makes my arthritis flare, so my joints are hot and swollen.

Whilst I have always been susceptible to chest infections I have never had so many in a year.  It takes ages to recover from each one and then another one starts.  I wonder if anyone else has had a similar experience and what worked for them.  I am struggling to hold down my job and look after my family - my husband is disabled and unabled to work as he has MS.

Any advice or suggestions would be gratefully received - just so fed up with being ill all the time!

[geminigirl1963]

It is my understanding that methotrexate itself can lower your resistance to infections and that can very well be why you've had so many - especially if you're already prone to breathing problems/chest infections (I, too, have severe asthma and am very prone to chest infections).  Another issue could be that possibly the infection you're being treated for hasn't fully "gone away" after the course of antibiotics and therefore, it comes back very quickly.  I'm wondering if a longer course of treatment with antibiotics, or even a different antibiotic than the one you usually take, might help.  Sometimes if you normally take the same antibiotic for an infection, you can almost build up an "immunity" to it so it might not work as well as it used to for clearing up the infections.

Also keep in mind that, while the steroids definitely help with breathing issues, especially when you're dealing with an infection, they also tend to lower your resistance to infections.

I'm no medical professional - just giving information related to my personal experiences - so any and all changes to your treatment should be discussed with and approved by your physician/s.

I hope you feel better real soon.  Keep us posted!

[txsilver]

I am sorry to read you have been battling infections.  Geminigirl made some excellent points regarding the meds.  Honestly, I have never heard of anyone taking the combination of sulfasalazine and methotrexate.  Have you talked to the doctor about stopping Methotrexate for awhile or trying something else?  Have you gotten a second opinion on the best treatment plan for you?  If not, that might be a good place to start.  Hang in there as best you can.  I wish for you speedy relief!

[bmcbeth]

Good to speak to someone else of 1963 vintage!

You certainly make some good points.  The first antibiotic I'm given is usually amoxicillin, which doesn't shift it and then I'm put on to doxycycline or erythromicin, which sometimes do the trick and sometimes don't, thereby needing a third course.  Unfortunately the doctors always seem to want to give the minimum duration of antibiotics and steroids and I often have to go back for further courses.

My doctor has shied away from giving me steriods in the past to try and protect my immune system, but usually things deteriorate and we're left with little choice.  I'm so frustrated that we just seem to be firefighting all the time and not really managing the various conditions and the interactions between the meds.

Thanks for your good wishes.  I think I might be going back to the doctors soon as the infection isn't clearing (now on second course of antibiotics and second week of steroids), so will raise the general situation with him then.

Kind regards.

[bmcbeth]

Hi there, thanks for your posting.

Apparently it is quite common in the UK for sulfasalazine and mtx to be used together, but that's just what I've been told.  I've not taken the mtx for a couple of weeks (as per user guidance) to try and give my immune system a fighting chance but obviously it hasn't worked - and my joints are flaring.

I was only diagnosed with PsA a couple of years ago (despite having had joint pain for years) and knew from friends with RA that getting the right drug and dosage can take time.  Having read your comments I think that I do need to challenge a bit more - thank you.

Kind regards.

[geminigirl1963]

Hello fellow 1963'er!!

I would definitely get back with your doctor if you feel that the infection isn't clearing.  In the past I have had to push the docs to give me an extended round of antibiotics and steroids to get me "over the hump".  At first they were leery of extending the steroids (more so than the antibiotics), but they have come to realize that I know my body and how it reacts and when I need more of the steroids, so they tend to listen to me more now.  It helps when I remind them that in the past I had been placed on a ventilator 5 times in one year because of my asthma and recurring infections.  Definitely don't want to go through that again!!

It sure is a frustrating process when you're dealing with multiple health issues (I do also) and multiple medications.   It can be a very tricky situation trying to weigh the pros and cons of one treatment course over another.

I've found that a Z-pack sometimes works quite well for me when I get bronchitis or pneumonia.  I'm allergic to both penicillin and eurythromycin (and just recently found out the hard way I'm allergic to Bactrim - almost had to call 911 for that one), so my antibiotic choices are somewhat limited.  Docs have told me that azythromycin (the med in Z-pack) is somewhat similar to euryhromycin, but I don't seem to have a problem with it, so it's usually the first thing they try.

I also find that when I'm fighting an infection or virus, it makes my arthritis and other health issues worse.  One GOOD side to the steroids is that it also makes my joints hurt less!  But I sure don't want to live on prednisone for the rest of my life either.

I hope you start feeling better real soon!

[NewLeaf]

I have had similar problems with chest infections for the lkast 4 years due to RA meds complicated by asthma and alergies.

HAVE YOUR SPUTUM CULTURED

The ony reason I have had a relatively good year is that I finally begged my RA doc to culture them in 2008 and it came back with a GRAHM NEGATIVE  Pseudomonas bacteria which is resistant to the normal antibiotics and had to be placed in the hospital for an 8 day course of IV antibiotics. Due to the repeated infections that never really went away I now have moderate lung damage. Look up Bronchiectasis which is lung damage from untreated infections you realy don't want to go there. I now cannot take a walk without struggleing for my breath or do any housework which I used to do at my slowbe RA pace before and now I can't.

Please, everyone, take chest/lung infections seriously.