I've had some mild-to-moderate cognitive impairment, mainly what seems to be a lower functioning working memory and just a slowing down of my normal mental processes. My rheumatologist said that might be a medication side effect for methotrexate. Has anyone else had this experience with methotrexate or other DMARDs, and how have you coped with this? I am in school again, and am doing fairly well, but I am not able to excel in the manner I'm used to.
I experienced something like this when my disease what at its worst, and my treatment wasn’t doing anything for me. I was depressed, and my mental processes were noticeably slower. So were my physical ones: I did everything very slowly. I also had the classic “brain fog”, which didn’t help matters either. How did I cope with it? I didn’t! It was just the way it was. All of it cleared when the biologic took hold.
At the time, I was aware of its happening, but didn’t go to the doctor about it, because I had a feeling that it would get better when my disease was better controlled. Here’s what I think I had (this is me self-diagnosing) –
http://www.wisegeekhealth.com/what-is-psychomotor-retardation.htm
Yep - I found the same issue, however it was definitely the PsA, not MTX. Like Seenie, once I had effective treatment (which I also found with my first biologic), it cleared. Prednisone also helped it (however caused way too many problems on its own - I’m not suggesting you consider that)
Me, three--I agree with Seenie and Jen. PsA can definitely give you brain fog. I've wondered if part of the problem is because never feeling "right" our brains are constantly being interrupted by pain or discomfort signals. Just being so fatigued and weak ALL the time certainly must affect our thought processes. Yep, Enbrel makes a difference.....prednisone does, too--but, avoid that unless you're desperate!
I'm relatively certain it's the methotrexate, or at least worsened by it, because the impairment peaks the morning after my injection and gradually improves over the week. I always dread doing it, but I experienced a significant increase in symptoms after halving the dose for a couple of weeks, so I just deal.
I have felt less general fatigue, in the past three months since I started Enbrel.
Rosen, I know nothing about methotrexate other than it made my mom sick and she stopped taking it (she had/has polymyalgia) and from what people say on this support group. I did ask my dermy about it when she prescribed me Enbrel, and her knowledge of mtx was it's on its way out because it isn't useful. I trust her knowledge because she's from the MAO clinic in MN. There are so many mixed results/opinions about it from members of this support group. I would have a really hard time taking something that gave me bad SEs--it's like two wrongs don't make a right. Maybe your doctor can come up with a different med to complement your biologic--or, maybe if you slowly get weaned off the mtx the biologic will do its job alone. I wish you luck in figuring this out!!!!
rosen said:
I'm relatively certain it's the methotrexate, or at least worsened by it, because the impairment peaks the morning after my injection and gradually improves over the week. I always dread doing it, but I experienced a significant increase in symptoms after halving the dose for a couple of weeks, so I just deal.
I have felt less general fatigue, in the past three months since I started Enbrel.
My disease has been under control, and the methotrexate's impact on my cognition and energy level is quite obvious even when the fatigue is lessened and inflammation is decreased. I won't argue that it doesn't have therapeutic value, but it is a cytotoxin. It's bound to do some nasty stuff. My doctors agree that's what is probably causing my cognitive problems because the trajectory of cognitive symptoms correlates with the timing of my weekly injection.
The discussion on whether it might be the disease rather than the medications causing issues reminds me of my fellow mental health workers trying to convince clients with schizophrenia or schizoaffective disorders to take antipsychotics, which are pretty side-effect heavy, like methotrexate. It's amazing how much cognitive dissonance has to be worked around to convince someone to stay compliant with a medication regime that diminishes quality of life in so many ways. I think sometimes it's easy to get so focused on medication compliance being the only answer that we forget that sometimes people just don't get better with meds, or they really might be having side effects that make the meds not worth taking.
Grandma J- I see my rheumatologist next week, and am going to chat with him about alternatives. I seem to be tolerating Enbrel pretty well. I want to get off the methotrexate in the next couple of years anyway, so that I can consider another kiddo in a few years. :)