Anxious first day of methotrexate

clairegilbody1

Hi everyone, I have been advised to start methotrexate for PSa. I have done all my reading and I think I have properly scared myself to death. I have popped my first pills, had the folic acid in preceding days and am just wondering when and if any of the side effects will show their face. This website has been really helpful in putting it into perspective. Also anyone with PSa experience really painful skin with no obvious rash? Thank you

annabanana

Hi @clairegilbody1 , great to hear that you’re ready to start methotrexate, hopefully it will help provide you with some relief! I cannot speak for PsA but I took it for RA and the only side effects I got were occasionally mouth ulcers, nausea and some hair thinning; obviously each person is different and these are just my experiences but you truly shouldn’t feel anxious as so many of us have been through the same thing and are here to support you. I will attach a link on methotrexate to might comment as well.

https://versusarthritis.org/about-arthritis/treatments/drugs/methotrexate/

clairegilbody1

I think I’m a bit worried about the hair. Was it noticeable?

annabanana

@clairegilbody1 to be completely honest, I was the only person who noticed that my hair had thinned. It may be because I’ve always had quite thick hair, but I think it has more to do with the fact that we are our own biggest judge.

I did take biotin supplements and did biotin hair treatments around every 2 weeks to help and I think it stopped more hair from falling out but didn’t help the already thinned spots. I’ve heard of people having regrowing success with different hair serums and such but I have only tried the biotin.

Rose27

hi @clairegilbody1. Hope you aren’t having bad side effects and Mtx is working good for you. I’m starting next Monday and I’m feeling scared as well. Is there anything that you’d recommend for the first weeks? Thank you

Arthuritis

@Rose27 @clairegilbody1 Many people have no side effects at all, but if they do, it’s usually nausea. It very much depends on your dose & your weight.

If you are new to it it’s best to take it on Saturday night on an empty stomach with water and sleep off any side effects so by Sunday PM the side effects are gone. You want it absorbed fully as efficiently as possible and not adsorbed onto any food.

You take folic acid 24hrs after MTX.

Avoid coffee during that 24hr period, as it will blunt the therapeutic effect of MTX.

Hope that helps.

Rose27

thank you @Arthuritis I thought the folic acid should be taken two days before the Methotrexate instead. May I ask you why do you suggest to take it 24h after. And if coffee is not good, what about tea?

iwannerbeme

Hi,

I was advised to take folic acid on the days I dont take MTX. My understanding is that MTX works by blocking folate in the body, this also causes the side effects people can suffer with, hair thinning, feeling sick ect. Taking folic acid on the same day as MTX can stop it being absorbed. Taking folic acid on the other days stops the side effects by adding the folate back into the body, at least for many people. I didnt know about caffeine though. I am a coffee drinker and I know MTX is working well for me. I shall try drinking decaff on MTX day and see if my markers get even lower!

Arthuritis

@Rose27 MTX works by competing with folate for the same receptors and inhibiting rapid cellular replication - this slows down production of immune cells, however they are not the only cells that are rapidly replicating, hair, skin and digestive system as well as embryos also do that, which is why pregnant women need folate even more, and you can’t take mtx during pregnancy. Although often pregnancy results in a dampened immune system, thus a break from RA, possibly because folate is prioritised for the embryo (hence nausea and morning sickness in common with MTX, as both take folate out of circulation). Fresh green leafy veg has a lot of folate. Tea has less caffeine so not as mtx defeating as coffee. You might need to experiment a bit to see how much tea you can have without losing the immune damping effects while still avoiding too much nausea and other side effects.

Sadly immune suppression is a blunt instrument but it’s all we have to prevent joint damage. And of course avoid sleeping pills that induce deep sleep. Unfortunately that deep seemingly restful sleep also triggers the immune fight cycle, normally very beneficial but not when it’s seeing your joints as foreign invaders to be attacked.