injecting Methatrexate

[Painful1972]

Hi ive been on 10mg a week of methatrexate for about 12 weeks now and was wondering if there is a difference in injecting it or tablet form. I take it by tablet form at the moment and it was giving me some relief for awhile but recently I am in extreme pain that will not ease off at all. I rescheduled my appointment with my Rhuematologist as im just not coping at all, Im wondering also what is the highest dose you can go up to??
I need help urgently to try and get the pain under control.

[carolanivey]

You know, sometimes I think the biggest mistake we creakies make is actually reading the package inserts that come with our meds. (that was a joke!)

I was terrified of mtx and refused to take it for a long time, but seriously it has been in use for decades and its side effects are well documented. The percentage of RA patients who have serious problems with it are very low, and the good news is if your blood tests detect a problem, it reverses when you stop taking it. The only thing you really have to worry about is not getting pregnant while on it.

I've been on it for about 20 years, and even had a healthy child during that time. (Of course, I had to stop taking it for several months before trying to get pregnant.) I added Enbrel a couple years ago and have been very happy with that combination. I know Enbrel has its own risks, but I don't believe it's any worse than mtx. The alternative is doing nothing, and becoming non-functioning. I'll take the risks. :)

The frustrating part is waiting for the positive effects to appear. For the vast majority of RA meds, you have to give each one a fair trial of 3 to 6 months at each dosage to determine if it's right for you. When you're in pain, that's an eternity.

I'm doing well, thanks for asking. After losing my father last year then going off mtx and Enbrel to have my hip implant worked on, I started having some inflammation in several joints. But now that I'm back on the regimen, things are gradually settling down. I'm amazed I got through that period without a major flare - it has to be the combination of meds. :)

Hope to see you over on the CJ boards!

[Painful1972]

Thankyou carolanivey I'll check that site out!! I know I won't be using prednisone it just does absolutely nothing for me. I think Methatrexate still scares the hell out of me though. Ive had my dose increased to 15mg so im hoping I may see some more benefits. I hope you are all well and doing ok.

[carolanivey]

And gammalistens is absolutely right - don't be afraid to be a pest. When it comes to your health, YOU are your own best advocate. [[hug]]

[carolanivey]

Weight gain is the least of your worries with prednisone! Please, please stay away from this stuff if you can. The long-term side effects of using bursts of it off and on, aren't worth it. It can cause avascular necrosis (bone death) in your major joints like hips and shoulders, osteoporosis, sleep problems, the list goes on. Unless you absolutely can't function without it, try to avoid it.

And for the record, you're not a whiner. :)  At some point you'll find the right combination of medications for you, and you'll feel better. Maybe not perfect, but well enough to get a good chunk of your life back.

There's a great, supportive message board at creakyjoints.org. Not taht this one isn't great, but the CJ board is a bit more active and you'll truly find people who understand.

[Painful1972]

Thankyou Gammalistens for your well wishes. I actually have attempted Prednisone 3 times once orally and twice injected and have no response from it whatsoever. My Rhuemy still doesn't understand why as she said it should help, but ive actually told her it feels like it makes it worse.  I understand your concern with the weight loss though because none of us what to add anymore stress to our bodies. I dont mean to whinge and sometimes I wonder am I just being a baby and then I think maybe Im just a whinger or maybe even just expect to have no pain :( It really messes with me mentally as well as physically. And some days you think its really bad and then another day you can wake and think omg this is 10 times worse why was I complaining the other day. Do any of you feel this way or am I just insane???

[Gammalistens]

I am on Plaquenil 400mg and it's not working. What did help when I was having a bad flare was a Prednisone Pack. I am supposed to be taking 10 mg a day, but I gained so much weight that I quit taking it. It really did help the pain though. I am not sure if you can take it with Methatrexate, but it would be worth asking your doc.
I understand your frustration with pain and fatigue. It's just rotten, especially at your age.
But thank God we have disease modifying meds that at least slow the progression of deformity. I wish I could send you a miracle, because I know it hurts. Remember that doctors are there to help us, so if the naproxen doesn't help, call her! Do not worry about being a nuisance! If you're hurting, you need help!
Good luck. I'll be thinking of you!

[Painful1972]

Thankyou so much for sharing I find you really get better answers from the patients themselves than the doctors :), after all its us that take it. I am suffering really bad at the moment so I went back to my Rhuemy earlier and she has perscribed Naproxen as she feels this may help. Im not so sure as I tried lots of anti Inflammatories before I started the Mtx. Im struggling really bad with fatigue and can't work out why its come back so bad.
I didnt get to ask about injecting the mtx and dont know whether I should bring it up with her.
Im so glad to here that you are doing ok with very few flare ups I wish I could be were you are, I hate this disease and I think im in that feel sorry for myself phase or confused stage im not really sure lol.

[carolanivey]

Oh, and to answer your other question about side effects, I had some side effects from oral mtx at the beginning but over time they faded. However I always had to be sure to eat something with the medication or I'd get nausous. And sometimes, not always, I'd get really fatigued after taking it. I don't notice any significant fatigue with the injections.

When I first started the injections, I went back to occasionally having a sore tongue (no open sores) for a while, but again, it went away after a while. Your body will often adjust if you're patient, and the effects aren't too severe.

[carolanivey]

My rheumie told me that the injections are more effective because the medication doesn't have to pass through your digestive system. Therefore you get more benefit out of essential the same dose. I think it has definitely helped. I wasn't doing terribly, considering how bad I've been in the past, but I was still having some minor inflammation and twice yearly flares (spring and fall). We switched to injectible mtx and things were better, but my rheumie felt like I could do even better by adding Enbrel.

Now for me, adding Enbrel was a long-term experiment. It doesn't make much difference in how I feel day to day, BUT I haven't had a flare since I went on it, and it's been almost two years. That's huge for me! It's worth putting up with the stinging injections!

[Painful1972]

Hi Carolanivey thankyou for the advice. Do you feel that injecting your Methatrexate is helping you more?? or is it soley for the side affects??

[carolanivey]

Hi, I also started injections last year after over 15 years on the pills. The highest dose I took orally was something like 20 mg for a short time. I believe up 25 mg can be given. Currently I'm injecting 60 units (equivalent to 6 tablets, or 15 mg). I was nervous about self injecting too, but honestly I've found it very easy. The medicine doesn't sting and the needles are tiny and I barely feel it if at all. The most painless place to inject is in the little "roll" below your belly button. :)  

I also inject Enbrel, which is a completely different story. This stuff stings like the dickens, but there are some tricks to make the process go easier - don't swab with alcohol before injecting; warm up the syringe; and roll a piece of hard candy around in your mouth while you inject. Weird, but it works. :)

[Painful1972]

Thankyou for your reply's Im going to see my Rhuematologist tommorrow as the pain is terrible. Im still unsure though whether or not I could actually inject myself. Anyway I am going to bring it up with her and see what she thinks. I just wish that I had gotton a little bit more relief from the MTX, maybe even a higher dose may help.

[txsilver]

Hello.  I have taken MTX in pill and injectable form and my opinion and experience is that I did much better on the injections.  The pills caused me to feel unwell and I suffered with the side effects as much as the condition for which I was taking it.  I did find that, while taking the pills, if I took them about an hour after a high carb meal like pasta I did better.  I also took leukovrian 24 hours after I took the pills.  This functions like an antidote to the MTX so it cannot be taken any sooner or you lose all the benefits of MTX.  
As much as I hated the idea of giving myself weekly injections, it really was the best way for me to take it.  

[rocketship]

I've been injecting mtx for only 2 weeks now.  They started me on that because I already had stomach issues and didn't want me to take the pills.  They told me injecting it could be up to 30% more effective because it doesn't go through the digestive track.  Don't know if that helps.