Methotrexate help

Ferj

Hi Everyone,

I am 37 and I have psoriatic arthritis. Only diagnosed November 2024 after 4 years of pain. I started methotrexate two days ago. First medication I tried I was allergic to it. I have had nausea all weekend, and pains in my abdomen. I’m only on 7.5mg this week. I’m just worried going up to 10mg next Friday. The nausea is annoying, but if I eat something small it does help. But I’m just worried it’s going to get worse as I increase each week for next 3 weeks.

Has anyone else had this experience and it didn’t get worse as they increased. Rheumatologist said I could switch to the injection but he said it is hard to do with lower mg. I have kids and just don’t want to feel unwell every weekend. When the arthritis has already been such a big challenge enough to manage everyday.

Also another question can the GP change me over to injection form or do I have to go see rheumatologist again?

Thanks so much for any advice. Just new to this all 😊

MrDJ

Hi

I believe only a rhuemy can change you over to the injection.

Ive been on methotrexate for 24 years and went straight onto 20mg and have stuck there ever since. at one point they tried to get me to go on 25mg but i refused.

Sadly nausea can be one of the side affects but it was random for me, i could go weeks or months with no after affect and then an hour after i took 8 of them they made me feel nauseas but only for an hour or so. i cant remember having stomach issues. do you take after a main meal as thats what ive always done.

If you are under the rheumatologist then it maybe worth a call to see if you could speak to one of the specialist nurses to ask advice as meds affect us all differently.

Arciere

hi there

I just thought I’d say that if Methotrexate doesn’t suit you - then do push your Rheumatologist to change to something else. It feels like they always start with Methotrexate but there are lots of other things.

It didn’t suit me and now I take something else. So there are other options is what I’m trying to say.

Woofy

go on to the injections if the nausea is bad. Or you could try taking your tablets after you evening meal. I was on tablets to start with, but moved on to injections because they increased my dose to 25mg, and that would have been a lot of tabs lol.

Also on all the other days I was prescribed folic acid. I was lucky as I didn’t feel sick on the tablets.

Ellen

A quick hello to you @Ferj and welcome to the online community.

You have had some great advice from our members.

My own would be to bear with it for a while trying some of the advice here - taking your MTX after a meal or before bed - and if you are still struggling it's back to rheumatology. If you have a helpline call them they should call you back and possibly prescribe folic acid. It can mitigate side effects taken as often as every day except MTX day as mentioned by Woofy.

I totally understand what you mean about the disease already affecting family life so the last thing you want is to feel ill every weekend.

Do let us know how you get on

Ellen.

GillH

Hello. Hope you feel a bit better soon as become more established on the medication. I am interested in how you (and others) find this treatment as I am waiting to get started on methotrexate since sulfasalazine and me were not getting on well together (I spent most weekends unwell). I was told to take a few weeks off all meds (obviously brings other issues) before starting new ones. I am concerned about the possible nausea though. I guess I will only know once on it as everyone could be different. I hope you find an option that does work for you.

Arthuritis

@Ferj @GillH I have recently restarted MTX after having a glorious drug free RA free holiday lasting 20months.
MTX has to be taken on an empty stomach otherwise it’s not effective. It works by competing with folate that fast dividing cells need to make new ones (T cells that wreck your joints, stomach, skin, cancer cells, for which MTX was originally designed before they discovered in low doses it was effective for RA). The most effective approach to minimise joint damage is to hit RA HARD & FAST, to stop it getting too established. The first time I took MTX over 10mg it was horrible super nausea and brain fog like you 5mg, 10mg, 15mg, no benefit until I was at 17.5mg, and later 20mg. After a baked beans triggered flare I was jacked up to 25mg/week.

However like others, the nausea period got shorter, from Saturday night to Sunday night, to just Saturday night. If it gets too much you can have some coffee, it attaches to the same receptors as MTX, and will take the edge off, but aim to wean yourself off. That nausea and sick feeling shows the MTX is doing its job, preventing the generation of brainwashed marauding hordes attacking invading and ruining your joints. You have kids for whom you need to preserve your joints, so I would suggest soldiering on with the tabs. I am not keen on the injections as they are larger doses and you can’t adjust to suit if say, you have an infection to fight off.

I don’t know what triggered your RA, but this research might help you avoid triggers:

https://www.ucl.ac.uk/news/2021/sep/targeting-gut-relieve-rheumatoid-arthritis

Sometimes there is light at the end of the tunnel, I got ~2 years drug & RA free, I hope you do too. I have posted here about how surprising things can be a trigger that keep you in RA, however the research link should help you plan what to do.

Ask away if you have any questions. You will get more help from the community here than you will from your rheumy.

Only had 1 NHS senior RA consultant give me an honest answer as to why there are no better solutions to RA: “There is no pharma incentive to fund research into curing when chronic treatment with biologics as it’s highly profitable and lasts forever”. The rest did not even want to know how I got myself into remission or to test to see if this could help others. They did do lots of blood tests and imaging, then decided to ignore the whole thing. I did ask why not investigate it as it might help others? Response “There are loads like you on our books, it’s not our job to investigate, there is no funded research into discovering how remissions work or even survey those who got it how did it happen”. Sadly the days of HM Gov grants for such expensive research are long gone, and its mostly pharma business led now.

If you want to learn more… about modern medicine & politics look up Dr John Lykoudis & Dr Barry Marshall. This will explain why it’s so frustrating.

Jenner, Fleming, Pasteur all made their big lifesaving discoveries before the involvement of regulators who depend on pharma for guidance, who in turn, have shareholders to answer to. Today Jenner, Fleming & Pasteur would have been punished for daring to think or rocking the boat like Lykoudis and Marshall. Marshall was persistent and went on to win a Nobel Prize for his discovery that seriously annoyed Big Pharma! (All documented on PubMed, and despite this, it took 15 years for doctors to accept their dogma was wrong). Or as another NHS consultant oft tells me in the world of medicine “Where there’s retirement, there’s hope!” wryly referring to his illustrious Prof of Medicine!

MrDJ

Interesting,

"MTX has to be taken on an empty stomach otherwise it’s not effective"

Ive never been told that in 24 years so will check with my consultant.

NHS website https://www.nhs.uk/medicines/methotrexate/how-and-when-to-take-methotrexate/

How to take methotrexate tablets

Swallow the tablets whole with a drink of water. You can take your tablets before or after food. Wash your hands after touching the tablets to remove any traces of methotrexate powder.