Hello. Methotrexate decision.

Dazzler13 Member Posts: 3
edited 12. Jan 2021, 12:26 in Living with arthritis

Thought I'd say hello.

I'm having lots of back pain (most of spine, sacroiliac and hip) which I think is undiagnosed Ankylosing Spondylitis (my notes say Sacroillitis). I have a diagnosis of Psoriatic Arthritis which I've been managing for 18 years with very little medication and I'm sure there is an overlap with these conditions. I'm booked for spine MRI this month to confirm/deny AS.

I'm at the point where I'm considering whether to start Methotrexate or not. I've avoided it for this long but I'm sort of at my limit. I'm 47 now and have a 3-year-old, a wife, and a full-time job, and my ability to cope due to pain is now a real problem.

I'm posting as I've read about some of the biologics which sound promising, and my consultants say that the first approach is using Methotrexate (same thing they've said for 18 years). Is that always the case? My consultant has said she would rather not start me on Methotrexate currently due to CV19 which I understand.

I also have to take blood thinners which mean I can't use NSAIDs as I can't risk a stomach ulcer (had one of those before due to Vioxx), which leaves me with 2mg Paracetamol a day to fight Psoriatic Arthritis/Ankylosing Spondylitis (sort of like bringing a knife to a gun fight?).

I'm not sure what my approach should be?



  • Ellen
    Ellen Moderator Posts: 1,656

    Hello to you too @Dazzler13

    I am very pleased to meet you and welcome you to the Community. We have a fair few members who have Psoriatic Arthritis and more who take methotrexate so you should get plenty of support.

    I see you are awaiting confirmation or otherwise of Ankylosing Spondylitis too via MRI very soon.

    You have done admirably well to cope with only paracetamol for so long, but the time has come when you need help. I can understand that and yes Methotrexate is the usual starting place before being offered biologics. You don't say why you are against Methotrexate (MTX), but many of our members are worried about taking it initially too. I am attaching a link to a recent thread on the subject:

    Do keep posting I am sure the forum can support you with your potential extra diagnosis as well as starting treatment.

    Best wishes


  • Dazzler13
    Dazzler13 Member Posts: 3

    Hi Ellen

    Thanks for the reply. I'm nervous about taking Methotrexate as the potential side-effects sound pretty awful, and I'm worried about the long-term effect of taking a drug like this.

    Do you know whether I would need to take MTX via injection rather than orally as I am also on Rivaroxaban blood thinners?

    Thanks again


  • Ellen
    Ellen Moderator Posts: 1,656

    Hi Darren

    Of course you are nervous, most of us are when we first start a drug like Methotrexate, but not everyone gets the side effects.

    Consultants generally start people with the medication in tablet form, but you can discuss this with your consultant. I think he/she might be pleased you are considering taking it.

    Do keep posting our members really will support you.

    Best wishes


  • frogmorton
    frogmorton Member Posts: 29,493

    Hi Darren

    I am very pleased to meet you to and welcome you to our forum.

    Very impressed how long you have managed without meds and totally get why you are anxious about starting MTX. The side effects they list are proper scary, but loads of us don't have any at all.

    If you do there are things they can do to help too and you have regular blood tests to check how your body is coping with it.

    They have to tell us all the potential side effects don't they? To cover themselves.

    If it helps the side effects listed include for people taking it at much higher doses than we do like for cancer treatments.

    Let us know how you get on