Kickas.org Forums Rheumatoid Arthritis General Discussion #1 RA Web Support Group Increasing methotrexate dose

I've been slowly lowering my prednisone dose over the last couple of months to find out whether methotrexate is working. I've been on mtx for over six months now. As I've lowered the pred, my symptoms have worsened again so I saw my doc this morning to go over my most recent blood tests. As I expected my CRP and ESR have been going up again, mostly the ESR which had jumped from under 40 to over 60.

Looks like the mtx hasn't been working so the plan is now to increase my weekly dose from 15 mg up to 20 mg and then to 25 mg if necessary. I guess the higher doses increase the risk of side effects.

D'Darn it Wendy. What a shooter. Just soooo hope that this pain circle caan be broken. Many (((HUGS))) lass -

Molly C

Hi Wendy, Im not doing to good with this stuff...Im up to 15mg and tired of being sick. My condition has gotten worse over the last 2 months and im pretty convinced its not working for me. I know you have RA as i have AS. Is this your only option? I am thankful that i have other options and looking forward to trying them.

You mentioned you have been lowering the Pred and your symptoms have worsened. Wouldnt this suggest that its the Pred thats been helping and not the MTX?..i might have got twisted somehow.

Hi Reese,

yes, that's what I think it is. When I started mtx, I had a CRP of about 110 and my ESR was close (about 100). I could barely walk or move and mtx was going to take a long time to kick in so I went back on prednisone. My doc agreed that I should stay on a low dose of it until the mtx had a chance to work. We were worried about internal organ damage with my inflammation that high.

My blood tests showed steady improvement. I'd lowered the pred to 6mg per day and stuck at that for several months. Finally, we decided it was time to start lowering the pred to see if the mtx had worked. I've been lowering it VERY slowly - less than 1mg per month. Now I'm much worse so the speculation is that the mtx has not been working and it was the low dose of pred that was continuing to lower my inflammation rates.

I'm now going to increase the mtx to see if that will work.

If it doesn't work, there are other options to try. I think it's a case of working my way through them.

Thanks Molly. It's pretty crappy right now. I can't believe how many joints are involved - hands, wrists, elbows, shoulders, sternoclavicular, hips, knees, toes. Can't raise my right hand above my head at all because of my right shoulder. The left is slightly better but still miserable.

wendy, sorry to hear this, you work so hard, so methodically and logically at this, just not fair that its been such a rough road. if the mtx really doesn't seem to be working, even at a higher dose, what do you think you will try next? hope you get some better relief soon, you SO deserve it!

Hi Sue,

Thanks for your support. It has been a rough road and still is!

One of the links I posted has a great chart that helps to see what the progression will be. The link is the first one I posted, Diagnosis and Management of Rheumatoid Arthritis. The chart shows treatment approaches and suggests that, if 15mg of mtx per week doesn't work, to increase to 20mg or 25mg although it might be necessary to switch to injections at that point because the risk of nausea goes up with increased dosages.

If that doesn't work, the next suggestion is leflunomide (Arava) or azathioprine (Imuran). So I guess those would be the next possibilities.

I hate how long it takes to test each one.

it does seem to be a very long time, and i am most impressed by the amount of patience you demonstrate through it all. you certainly have managed to keep your head through it all far better than i think i could. we're all rooting for you!

Thanks so much, Sue. I must admit to having moments when I feel slightly desperate to fix it all. That's when I have so much sympathy with Chris (Tiredofpain) who is in a permanent flare.

Are you back at work now? Has your pain improved to the point at which you are able to work again?

well, if you do have moments of desperation, your sense of patience and level-headedness win out by far.

as for me, my upper back is finally a lot better. about a week ago i drove to work and it didn't seem to bother me at all, finally, took about 6 months. this past week, SI loosey goosey and been sitting on ice and heat, but really productive in the recliner, love my macbook air and wireless. so technically i could "go back to work" but also on sabbatical and can work from home, so doing that most of the time, papers and grants. go in when the students need me. thanks for asking, it was a really rough time. and as you mentioned for chris, those of you who seem to be just in constant pain for much longer than me, well, i have so much respect and admiration for you. and so glad to hear how much the MJ seems to be helping chris, i can even feel it in his posts.