Covid Booster (4th Covid Vaccine) & Methotrexate

Caleb1981

Hi,

I’m due to have my 4th Covid vaccine on Thursday and my GP surgery has suggested (sounds like they just made it up on the spot) that I skip Methotrexate for that week and start as normal the week after.

Is that inline with advice others have been given?

I’m genuinely not sure whether to have the vaccine or not. I’m kinda reluctant to stop Methotrexate, I’m only 15 weeks in and I think it maybe is working 🤞🏻.

stickywicket

On the contrary, I've always missed my meth when I've had my jabs to enable my immune system to fire up a little and help them work. I've also missed my meth for weeks sometimes, on instruction from my surgeon, before operations. I've had my 5th jab (They're on the ball in the Scottish Borders) and stopped my meth before and after it.

Arthuritis

@Caleb1981 @stickywicket My 2p worth. This might be more complicated. It maybe worth getting specific advice from a rheumy who is specifically studying this. I remember a video link posted here from one of the peer RA charities on this very topic on top up vaccination the Rheumy consultant on it recommended people on balance not stop their MTX as flare ups that occurred following a jab were much harder to put back in the box. A lot must depend on the strength of your immune system, and that depends on age as well as other factors. An older weaker immune system can be prevented from going on the rampage with a low dose of mtx, and conversely being weaker, would need to avoid immunosuppressants during times of challenge. However a younger system would multiply T cells at a prolific rate in the absence of mtx and with the vaccine acting as adjuvant/stimulant. These new rogue cells would take 2-3 months to die, ie, 2-3 months of pain after, not to mention that your immune system might adapt to render mtx useless without your full effective dose, rendering it useless and needing a new drug to replace it. I don’t know your age, but stopping mtx based on a casual gp conversation is not a good idea. Will the booster genuinely offer more benefit than what you have now with mtx keeping a lid on your RA?

FYI I am now on 25mg MTX, I regrettably lowered my mtx to 10mg due to an infection from a comfy20, months ago, and now 20 is no longer sufficient 😔

I declined covid boosters, as *just for me*, the limited benefit of a vax booster beyond the 2 jabs pre mtx did not justify a painful relapse of RA.

stickywicket

As usual @Arthuritis makes sense. I have had RA for most of my life and been on meth and hydroxy for well over 20 years. I also have dodgy lungs and a neck area where 'nothing is in the right place' (The ENT specialist). A bad cold could do for me so it makes perfect sense that I take all available jabs with all precautions.

Things do seem different for the younger, more recently diagnosed and those who have not been on DMARDS for long. An individual judgement from your rheumatologist would seem to be in your best interests. However, with the current dearth of consultants, I wish you well with that .

Arthuritis

@stickywicket @Calacake Found the relevant video…

https://youtu.be/PlswEXDPEro

The relevant section is at 3:19, if you don’t want to sit through all of it. Prof Siebert’s view.

Caleb1981

Thanks both @stickywicket and @Arthuritis for your comments & the video link.

As I wasn’t on methotrexate for my initial 3 vaccines, I think I’m going to hold off on the 4th one.

I will attempt to contact rheumatology for further advice.

JenHB

I wasn't on MTX for my first 3 - was only diagnosed this Feb! Had my booster in April (and hadn't been advised to stop) but was on 15mg. Really struggled for about a week and a bit afterwards with achy knees and low level fatigue - could still function and go to work (but wasn't 'firing on all cylinders') and had no energy/motivation to do anything social in the evenings. I'm now on 25mg... (and have since had covid and antivirals)

Caleb1981

Thanks @JenHB - Sounds like the vaccine wiped you out and like @Arthuritis, you’ve had to increase the dose of Methotrexate - that’s not good. The advice on whether to stop Methotrexate or not doesn’t appear to be consistent at all!

I decided not to get the vaccine yesterday - I think my gut instinct is not to reschedule it, but I’ll wait to see what the Rheumy team say, if I ever hear from them again 🤦🏻‍♂️. They’re now on a 7 day call back 😱.