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to Start Methotrexate?
I've just started reading some of the postings on your site and
found them to be really useful. Like
so many others, I am in my early 30s, having suffered from psoriasis for
about 10 years now, but only recently discovered signs of joint pain. Because
I'm only experiencing “annoying” joint pain in my knees, which my
rheum and I attribute to a mild case of PA.
I am very fearful that the PA, if left untreated, will become worse
I’m considering the
drug, methotrexate, but it is something I've so far avoided due to the
lifestyle changes it requires, like not being able to drink, etc.
Anyway, I have a question for you and others:
When would you suggest beginning on something like methotrexate for
the treatment of PA?
You said in one of
your past emails that you wouldn't recommend methotrexate to anyone unless
the pain was getting "debilitating."
But since PA is a progressive disease, doesn't it make more sense
to apply a more aggressive strategy to "nipping the disease in the
bud" and using methotrexate while the disease is still just in it's
"annoying" stage, rather than wait until it has become more
severe and potentially have already caused irreversible joint damage?
That is the issue with
which I'm struggling. I
don't want irreversible joint damage, but because the pain hasn't been
debilitating I keep putting off the decision to go on methotrexate.
Thanks for asking the question, Lynn.
It gives me a chance to perhaps necessarily qualify what I said
earlier. The reason I would
recommend postponing the use of methotrexate until the pain of PA becomes
debilitating (i.e., severely affects one’s lifestyle) is it is a drug
few people end up taking “forever.”
Many people take
methotrexate (MTX) for many years; others take it for only a few months
before its adverse effect on their livers compel them to stop.
I don’t know of any way doctors can “anticipate” how any
particular patient will respond to prolonged MTX therapy.
On the other hand, MTX
tends to work well for most people with PA, which means the chances that
it will make a debilitating condition bearable are good.
Assuming the worst, that you will only be able to use MTX for a few
years, would you like to benefit from it when your PA is mild or severe?
As long as I could
walk and drive and handle the pain of PA with Vioxx, I, personally, did
not feel compelled to take MTX. When
the Vioxx stopped working well, when I could not drive and required a cane
to walk, that’s when I started MTX.
Frankly, I did not
consider “irreversible damage” to my joints.
Nor did my rheumatologist or dermatologist ever say anything to me
about damage being “irreversible.”
Is PA or any other form of arthritis truly
reversible? I’m not an authority on arthritis of any kind, but
I’ve been led to understand irreversible damage comes when joint tissues
erode and the actual physical structure of the joint changes.
What I would call “debilitating” comes before this happens.
It was pain that
debilitated me — made driving impossible and walking agonizing — but I
was probably far from the advanced stage of joint degeneration.
The MTX completely restored my mobility.
Also, I don't believe MTX necessarily inhibits or stops joint erosion. Ask your rheumatologist. I basing this on my reading of this article at the NPF web site.
But that’s me and
that was then. MTX isn’t the
only alternative, now. Enbrel
and Remicade may be possibilities for you and you should certainly talk to
your doctors about them before deciding on methotrexate.
As I write this I am phasing off my second go at MTX and starting
Enbrel therapy. I am also (on
an orthopedist’s advice) taking a daily dose of glucosamine and
chondroitin. Time will tell.
“debilitating” means to you and your rheumatologist, Lynn.
Your doc may not share my fear about using
up your limited time on methotrexate before you might really need it.
In any case, do please
let us know where you go from here. -Ed