Methotrexate for Rheumatoid Arthritis and Common Side Effects
Methotrexate is one of the most common forms of treatment for Rheumatoid Arthritis and is arguably the most important medicine used to treat RA today. It is the staple of RA treatment since it is effective at reducing disease activity for a large percentage of patients and most people with RA will go on this drug at some point or another.
It took me years to work out how to get off all RA drugs. But I was determined, because my experience on Methotrexate was awful. After 3 weeks I genuinely started to get some relief from 10mg/week. It helped me by reducing pain approximately 70% for the first 6 – 12 months. However, after 2 years on that drug I was up to 25 mg/week and I was taking folic acid the day before and the day after to try to keep my liver together.
My liver enzymes markers of ALT and AST continue to be elevated, and it wasn’t just my liver that was struggling. I was falling apart emotionally, physically and mentally. I was so tired from the drug that it was a huge effort just to consider getting up off the couch to get a glass of water. I was borderline depressed (despite the personality of a german shepherd for the rest of my life prior!) and although I was alive, but I felt like I was not really living.
So, that is probably why a common question I now get asked is ‘How can I get off methotrexate?’. I show you the steps to doing that below, and in more detail in my free email training course., but first let’s do a quick recap on Methotrexate:
- Methotrexate’s brand names include Methoblastin, Trexall and Rheumatrex. It is called a disease-modifying anti-rheumatic drug (DMARD) and attempts to decrease pain and swelling associated with Rheumatoid Arthritis. In doing so, Methotrexate can prevent damage to joints and therefore reduce the likelihood of disability. Symptoms of Rheumatoid arthritis may improve within 3 weeks of starting treatment (which is precisely how long it took for me) but it may take 12 weeks or even 6 months of treatment for full benefit to be realized. Some patients do not see any benefit at all from Methotrexate.
- Although Methotrexate was only approved for RA treatment in the US in 1988, it had already been used to treat cancer and psoriasis.
- Typically, the tablet form of Methotrexate is taken once a week for RA, with dosage guidelines provided by the Rheumatologist. The starting dose for most adults with rheumatoid arthritis is 7.5mg to 10 mg. Around 25mg/week tends to be the upper oral limit. Methotrexate is also available in an injectable form which can be self-injected by the patient.
- It still remains unclear exactly how methotrexate decreases arthritis activity. It is known that Methotrexate interferes with certain enzymes which play a role in immune system function. Methotrexate prohibits the enzyme dihydrofolate reductase, thereby affecting the production of a type of folic acid, which is required for actively growing cells.
- Folic acid supplementation is required if you take methotrexate. Doctors vary in their approach with how this is prescribed. Sometimes the Folic acid is taken daily, in other cases it is taken in a larger dose 8 hours before and 8 hours after the weekly methotrexate pill.
- Methotrexate can cause an abnormal functioning of the liver. Therefore, it is very important to have blood tests on a regular basis to test for liver functionality. At a minimum, doctors will ask for blood tests every 8 to 12 weeks. However, there is a greater benefit to the patient if the tests are done as frequently as every month to allow not just the liver health to be reviewed, but the inflammation levels of CRP and ESR as well to view the overall disease activity. (Part of my strategy in seeking my RA cure was to be copied on the monthly blood test results and using the CRP and ESR to guide me as to how my holistic methods were performing. I strongly recommend you get your blood tested monthly for this benefit alone!)
- Avoid alcohol whilst taking Methotrexate since alcohol increases the risk of liver damage significantly.
- Methotrexate should not be taken if you are pregnant or planning to get pregnant. Methotrexate can cause birth defects and/or complications during pregnancy. This was one of the main reasons that I pursued a natural rheumatoid arthritis remedy. My wife Melissa and I were told we could not try for children until I stopped taking this drug, but I was on 25mg/week (at maximum dose). Do not fall pregnant whilst one of you or your partner is on methotrexate and for at least 3 months after you stop taking the drug. My wife and I waited 2 years just to be sure! This stuff is not to be messed with! We now have our first little one on the way and we couldn’t be happier!
- Besides the aforementioned side-effects on the liver, Methotrexate may also cause fatigue, nausea and vomiting. Personally, I found the fatigue on Methotrexate to be relentless – constantly tired 24/7 even if I was getting 8 hours of painful sleep. As with all drugs, side effects are usually dose-dependent.
- Some medications may alter methotrexate function. So, tell your doctor of all the medications you take (both prescription and over the counter). Also, NSAIDs, though often prescribed together with methotrexate, can affect the level of drug activity.
- If it works at first, it doesn’t mean that it will work forever. Treatment for RA often needs to be changed because the body can build resistance to a treatment. Some people find success with methotrexate at first and then later find that it stops working. Then, alternative drugs are tested or even a combination therapy is proposed where more than one drug is used at the same time.
Whilst taking Methotrexate it is still possible to reduce your digestive issues and, in turn, improve Rheumatoid Arthritis symptoms. This was something that I discovered myself, by remaining on Methotrexate whilst I implemented my holistic experiments until I was able to eliminate my inflammation. So the great news about Methotrexate is that unlike NSAID’s and antibiotic drugs, it doesn’t seem to interfere too heavily (if at all) on the delicate environment of your intestines, which is where the real cause of Rheumatoid Arthritis really lies. This means that your determined efforts to get well naturally whilst on Methotrexate will not be undermined by the drug side effects. Finally, some good news huh?! To reverse RA symptoms see my Rheumatoid Arthritis Diet and Natural Treatment
The Paddison Program is designed to work whilst taking your medications that have been prescribed by your doctor. With time, and as results permit, then the strategy for getting off medication for RA will be as follows:
- Follow the The Paddison Program to gradually reduce the inflammation and swelling in the body until your blood test readings of C-Reactive Protein (CRP) and ‘Sed Rate (ESR) come into the target range (See Appendix C in the Paddison Program eBook for information on blood readings)
- When favorable blood readings occur, and with the authorization of your Rheumatologist, move to a slightly lower dose of medication
- Maintain The Paddison Program natural therapy in the ‘consolidation’ phase (Phase 4) on your reduced medication until blood tests results of CRP and ESR again indicate normal
- Repeat step ‘2’ until you are no longer on medication and are holding quality blood test levels, drug-free!
You will see that all of the above can be achieved without the overuse of supplements and complicated meals.
Following the protocol exactly as it is outlined in the Paddison Program, I was able to stop taking all of my medication and return my inflammation levels to normal. It is my upmost wish for you to do the same and once you get started on the Paddison Program you will learn exactly how to go about it, step by step.
What have been your experiences with Methotrexate? Leave me a comment below.
“The best doctor gives the least medicines” – Benjamin Franklin
Clint Paddison is a previous sufferer of chronic Rheumatoid Arthritis and author of The Paddison Program for RA which treats Rheumatoid Arthritis naturally.
NOTE – This article is not medical advice. It only expresses the views of the author’s personal experience. For all changes to your diet and lifestyle first consult a licensed physician.