Methotrexate complications?

April 21, 2004 10:20 PM

Any long-term methotrexate users out there? [more inside]

Having been diagnosed with Ankylosing Spondylitis my rheumatologist has me on IM methotrexate for the 'indefinite future'.

I know about the blood tests and liver biopsies but anyone had first hand experience with long term use?

posted by karmaville to health & fitness (4 comments total)

I also have ankylosing spondylitis; have had it since 1997. Talk to me.

I'm surprised you're on methotrexate; I thought they'd try one of the NSAIDs first. Not that six and a half years of more or less constant naproxen (or diclofenac, or celecoxib, or indomethacin, which I also tried) is all that healthy for your liver (and stomach lining) either.
posted by mcwetboy at 5:14 AM on April 22, 2004

I've been on it for psoriatic arthritis for a few years on and off. I haven't had any problems so far. It does seem to help, though it takes a few weeks to notice a change.
posted by timeistight at 9:03 AM on April 22, 2004

I've been on diclofenac since diagnosis (~ 9 months), it didn't really make too much of a dent. So the doc put me on oral methotrexate which worked ok.

I stopped taking it for a few weeks due to a funky liver test but was almost crippled by the pain. So she put me back on, this time as an IM injection, which I have been doing about a month. I just look at the long term warnings and wondered how others had fared. Thanks for sharing your experiences!
posted by karmaville at 11:42 AM on April 22, 2004

Diclofenac didn't make much of a dent on me either, and I was taking 2x the normal maximum dosage. It also gave me a funky liver test. The hepatologist I spoke to said that diclofenac was known to do that.

Different people have different reactions to medication: I, for one, couldn't hack the indomethacin and react best to naproxen; I've met other AS sufferers for whom the opposite was the case. A lot of it is trial and error: try something for a few weeks -- and it has to be that because a lot of these things only work on the long term -- and see if it makes a difference.

In the end, I started on naproxen (1,000 mg/day, bumping up to 1,500 mg/day during flareups), tried celebrex (too weak) with indomethacin during flares (too loopy), tried diclofenac (not strong enough, wonky liver), diclofenac with sulfasalazine, then went back to naproxen. I take something for the stomach to compensate.

If diclofenac isn't doing it then you, like me, probably need something industrial strength. I can see how your doctor went to methotrexate, then, but I was under the impression that methotrexate was a bit more last-resort than that. IANAD, but I might have expected attempts with naproxen and indomethacin, say, before resorting to that.

One thing: stress is a definite factor in terms of flareups and overall pain management. Something you may want to think about. Managing your stress may have as much of an impact on your quality of life as the right medication.

Contact me privately if you want to chat more. AS isn't very fun nine months in; it took me years to get over it and basically assimilate it into my daily routine -- figuring out what I could and couldn't do any more. (For example, I have to sit down after 90 minutes of mall walking, shopping, or visiting a museum or gallery -- the slow pace is not good. On the other hand, I can hike 18-20 km in the mountains without incident. Go figure. But I digress.)

Not quite on topic, but hopefully useful. Good luck!
posted by mcwetboy at 12:07 PM on April 22, 2004