Arava (leflunomide) and Methotrexate at the same time - any experiences?

About 6 months ago I got PsA - the year before was typical niggles, 6 months ago like being hit by a truck. I started very slowly taking 8 steps forward and 7 back about 6 weeks after onset. I’m on methotrexate, and by clinical measures would probably be considered a responder. But I’m only 36, with a two year old, working as senior management in a mining company (only workaholics and alcoholics need apply). So I’m pretty determined to get as much of my potential back as I can - I need to have more energy to be an engaging, patient and loving parent, and a lot more to do that and continue to do my job well (good thing there is a boom on - otherwise I would have lost it in the severe 6 - 8 week onset late last year). So, my major option remaining is to combine Arava with Methotrexate. (for all those US people - unless I fail everything and have high ESR and / or CRP - which I among many haven’t had so far, TNF are full paid +20,000k per year, so possible but a last resort). So the stuff i have read about Arava sounds pretty harsh, and i havent found too much about the MTX Arava combo. I’m probably a rather reckless soul when it comes to these possibilities, but the combo idea is giving me pause, so any news of your experiences would be welcome.

Hello, JenAus

Nice to meet you, but not nice that you've got our shared affliction! I was officially diagnosed 9 months ago, although my symptoms were apparent for several years before that. (Docs just looked at me funny and said things like lose weight and get orthotics.) Looking back on it, I think my PsA surfaced about 10 years ago.

In September, my rheumatologist started me on 20 mg oral MTX. I had no response, either good or bad. In January, she added sulfasalazine and hydroxychloroquine. Still no response. On my return in May, she gave up on the S and L, and upped my MTX to 25, delivered by injection, and added 10 mg of leflunomide (Arava). I was not a happy camper, and she promised me that if this combo didn't do the trick, we'd move on the a biological.

You're right about not much being written about the MTX/Arava combination. I searched and came up with very little, but apparently it is done and relatively safe. ("Relative" being the key word ...) I did find this: and

When I went on the MTX, my rheumy said "You cannot drink while you take this." When she added LEF, her pronouncement was "You REALLY REALLY cannot drink while you take this.". After a month on the MTX/LEF cocktail (and poison pharmaceutical cocktails are the only kind of cocktails I've had since starting MTX) I've noticed no effects at all. If anything, I'm getting worse. And I have to tough this regime out until September, when it will have been a full year since diagnosis. I keep hoping that my hair will fall out so that I can move on to something that stop his hideous disease and the pain. PsA is a vandal and a thief: it's wrecking my body and stealing my life.

Good thing you're a workaholic, right? LOL Keep in touch, and best wishes for a solid remission


HI Jen I took MTX and Arava combo. It worked well for me for about 18 months. I was injecting 15mg of MTX and taking 20 mg of Leflunomide (Arava) every other day. At the 20mg daily dose I was in hysterical nausea I was so ill it made MTX look like a picnic and I went to every other day. Any ways sometimes the rheum will start you with a loading dose of 100mg (then 10mg daily or 20mg daily) it jusmpstarts the LEF to get it into your system faster as it is cuumulative. Like I say, it was great while it lasted. PsA being a progressive disease ,(and mine just motors along dandy like,) it did not last and I got to go onto bio's. I had failed on one nsaid, and 2 dmards. I do have a SED rate and I had a lower CRP( it was 11). My SED has been as high as 68 and on the lef/MTX blend I hovered at 14-16. Increased pain got me onto humira.

Hopefully you will find some relief with Arava. It is a good drug. I was happy to take it but do better on MTX/Humira combo. If you were a fast responder ( I am too) you will find a great improvement in symtoms in aout 4 weeks. good luck