Methotrexate Alternatives?

B_LIN1979 Member Posts: 5
edited 28. Nov 2023, 14:10 in Living with arthritis

I’m new to this site and joined after searching online for alternatives to Methotrexate.

I’m 43 and have had psoriasis for about 35 years. Painful joint symptoms developed over the last ten and I was diagnosed with psoriatic arthritis.

I’ve been taking methotrexate for over a year now and currently on a dose of 17.5mg with the standard 5mg folic acid 48hrs later.

The medicine is the only thing in all this time that has worked in terms of almost completely clearing my psoriasis, and the arthritis is much more manageable.

I do however really struggle with the side effects, and feel awful for a few days after administering. My mood is very low, I’m irritable, I feel anxious and forgetful and have reached a point where I feel I can no longer continue with the methotrexate.

I’ve tried taking this medication a number of ways - spitting the dose, increasing folic acid, lowering dose until it is still just about effective - but all have the same result.

I’ve raised this with my consultant and he suggested continuing but at my next meeting I would like to request an alternative.

My questions for the forum are; has anyone else had a similar experience with methotrexate and if so what alternative medications have you found to be the most effective?

ideally I’d like to find something that works just as well but without any mental side effects - I can cope with stomach ache, fatigue or skin irritation but not depression.




  • Louisa77
    Louisa77 Administrator Posts: 245

    Hi @B_LIN1979

    Welcome to the community.

    You mentioned having psoriatic arthritis and although methotrexate is working for you the side effects are not. This is such a common one unfortunately and is trial error to find the medication that works for you. You might have seen our info outlining the treatments available but I've shared it below

    Here are also some of the discussions on this condition in case there are some useful info, or maybe you could reach out to some of these members Psoriatic arthritis — Versus Arthritis

    I wish you all the best with trying another DMARD that doesn't have the side effects.

    Keep posting and let us know how you get on, I'm sure some of our members will be along as well to offer support.


    Need more help? Call our Helpline on 0800 5200 520 Monday to Friday 9am to 6pm

  • frogmorton
    frogmorton Member Posts: 29,020

    Morning @B_LIN1979

    Sounds like you're really struggling on MTX😕

    First of all have you tried taking it in injectable form? Some people find that makes a difference. Just a thought and quite probably not one you fancy trying now. Sounds like you've maybe had enough.

    This has a list of DMARDs

    I don't think Hydroxy is ok for psoriasis (might be making that up, but I'm sure someone said so), but the first list are all of the more standard meds people try.

    Take care and I hope you'll let us know how you get on.


  • I’m in remission at the moment !

    what I can tell you is I will not be going back on methotrexate!

    sinve I’ve been off it I’m back to my normal self ! Active happy and very motivated it helps I have no joint pain atm

    U need to insist it’s ruining your quality of life it’s ok being pain free but it’s affecting you in different ways x

  • jamieA
    jamieA Member Posts: 605
    edited 12. Apr 2023, 10:24

    Hi @B_LIN1979

    I also have had psoriasis for many years, with PsA diagnosed in late 2020. I'm on 3gms sulfasalazine daily, 10mgs MTX weekly and the biosimilar adalimumab Amgevita every two weeks. From the MTX outset I was prescribed 5mgs folic acid every day except my MTX day. I recently attended a Nuffield Health Joint Pain programme and there was one other PsA sufferer and an RA sufferer on the course. Both were on biologics only as MTX hadn't worked or disagreed with them. Maybe it might be worth discussing that option with your consultant.

    I think many people on MTX suffer fatigue after taking the medication. I know in my case either the day after or 2 days after I feel really tired and wiped out. Some people here have suggested moving the day you take MTX to say a Friday so that the symptoms don't cause issues with work etc.

  • CCM
    CCM Member Posts: 113

    I ws given injectable MTX for RA. All the symptoms described above. Was moved to oral sulfasalazine, without lessening efficacy. Keep the faith an answer will be found.


  • B_LIN1979
    B_LIN1979 Member Posts: 5

    Hi everyone,

    thank you for your comments and information. The links are really useful for outlining alternative medication - some of it is a little mind blowing for my non-medical brain but it will be really useful to attend my next consultation armed with a little more information.

    In the meantime, if anyone else has a success story with replacement medication - please share!

    Thanks so much again. These forums really are a big help. Ben x

  • Jane68
    Jane68 Member Posts: 29

    Hi Ben,

    I've been on Methotrexate injections since last September but have been told to stop as my liver readings went too high. I felt really unwell on it and still had daily pain and stiffness.

    Just got back from appointment with consultant who has suggested either Hydroxychloroquine, Sulfasalazine or Leflunomide instead.

  • B_LIN1979
    B_LIN1979 Member Posts: 5

    Hi Jane,

    thank you for your comment and sorry to hear that you haven’t been well on the methotrexate. It’s so interesting to hear the wildly different affects this medication has on people.

    I was also offered the injectable form but feel quite sceptical going off some of the stories I’ve heard. I’m just not convinced that the side effects will be any less manageable.

    I’m hearing the names of the alternative medication you’ve mentioned more and more now so will raise this at my next meeting.

    Thanks again and I hope you have much better results when you try one of the alternatives - would be really interesting to hear how you get on.

    best wishes - Ben.

  • Jane68
    Jane68 Member Posts: 29

    Hi Ben,

    I went for the Sulfasalazine in the end and am on day 2 with blood test next week to check liver levels have reduced. I'm loathed to take the Hydroxychloroquine as it mentions regular eye examinations are needed.

    My consultant said I had to try 2 different medications before he could put me on a biologic.

    I hope you get some answers at your appointment and don't have to wait too long for it.

    Best wishes,


  • stickywicket
    stickywicket Member Posts: 27,599

    In case it's of use.

    I've been on a combination of methotrexate and hydroxychloroquine for over 20 years for RA with no problems worth mentioning. (@Jane68 , hydroxy is a mild DMARD and my optician checks my eyes when I go for my annual test (because I've worn glasses since I was at school),

    But (and @B_LIN1979 this might be of use to you) it seems to me, after many years on here, that, where methotrexate is the normal starting med for RA, those with PsA are more likely to be started on sulfasalazine. I could be wrong but, if I had PsA and was given a choice, that's what I'd be asking for.

    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright
  • Jane68
    Jane68 Member Posts: 29

    Thanks stickywicket - I'm glad you're able to take both methotrexate and hydroxychloroquine. I've felt so much better in myself since I was told to stop the methotrexate. I've read it's the gold standard for RA but my liver just didn't like it.