How fast did these two medications work for you?

Symptoms & Treatments
1

Does anyone know how quickly methylprednisolone pills work on skin psoriasis? Not to clear it but to make it go from unbearable to at least allow sleep.

Also, how quickly did methotrexate reduce the severity of your skin psoriasis? It doesn’t matter if it clears it, I just need to stop the extreme itching and progression.

I don’t know whether I should spend 6 days on the methylprednisolone before starting methotrexate or just start the methotrexate. It’s an emergency, because I’ve hardly slept in at least a week. My doctor is completely useless, possibly to the point of malpractice. I have both medications here, but no clear instructions and no real access to ask questions. It could take a week or more to get information from the doctor. All they said about the methylprednisolone was something like “take it if you want” without explaining what it is. I’m still on biologics, but they are failing and the doctor seems to want me to keep taking the non-working biologic or just forgot to tell me to stop taking it.

I’m wondering if I could just start the methotrexate today and then find some kind of topical medication that can be used on large areas (arms, legs, neck) that would reduce the severity at least enough to sleep until the methotrexate starts working. I don’t know how I could get a prescription but maybe my primary care provider could figure it out.

My most urgent problem at the moment is that I need to figure out how I can sleep normally as soon as possible. The arthritis is mostly okay, but it’s just the skin psoriasis that is the problem.

2

I’m sorry to hear how miserable you must be. Sleep and coping go hand in hand and you are right to look for a solution. Methotrexate and most biologics tend to take weeks or months to kick in but the steroid often makes a difference within 48 hours. I have struggled with inverse psoriasis and it always starts on my eyelids…they itch, burn and peal. I was prescribed Protopic by a dermatologist as a topical ointment and it works fantastic for me and it isn’t a steroid. It knocks psoriasis on its ass quickly and with few treatments. You can look it up on line. It comes with the usual host of side effects but at some point of misery, one just doesn’t care. You may have to use it in patches rather than all large areas at once. I went from Humira to Rinvoq and the Rinvoq has given me 3 years with barely a hint of psoriasis. If I were in your shoes, I would listen closely to a good pharmacist…they likely have the answers you need regarding dosage etc. Who ever is prescribing your biologics and methotrexate are obligated to give all details as to how and when you should take it. Folic acid is usually taken with the methotrexate…I was on 5mg folic acid with MTX. Hope you find a quick solution!

1 Like
4

Sadly pred has a habit of increasing psoriasis plus it will seriously make your sleep go haywire. However as against that it might dampen down the crazy itching etc. To get the most out of pred you need to take your daily dose as early as possible in the morning, no later than 7am. I used to wake myself up at 4am to take it. As doing it that way allowed me to fall asleep at my regular bed time.

Regardless of your sleep issues pred has the ability to make your PsA feel a lot better though. Most people get really positive on it. But some of us can get truly psychotic on it too and have rages. Which is pretty terrifying. I’m a positive pollyanna on pred, my mother was practically psychotic on it. So go figure.

So a 6 day course of pred is good if you want your PsA to feel better, less good really for psoriasis issues.

With mxt the max dose for just PsA is 25mgs, the max dose for severe psoriasis is 30mgs, but we work our way up usually starting at around 15mg or lower. It can work faster on psoriasis than PsA too but no cDMARD works fast. You are looking at 3 to 6 to 9 months at least 25mgs to find out if it’s going to work for you. There is never a gaurantee any med will work for us either remember.

Loads of people take mxt with little or no side effects. We tend to hear less about those people as they’re just fine and dandy and don’t post on forums about it. Others can get quite severe side effects from severe brain fog, to nausea to the point of vomiting, and diarrhoea and feeling just drained and lost. One really good tip on taking mxt is to drink at least 3 litres of water the day before, the day of and the day after taking mxt especially if you’re taking it via tablets and not injection. Also get 5mg of folic acid prescribed to take every day except the day you take mxt.

But honestly for severe psoriasis as @Amos said you also need a topical medication. There are a host of topical medications out there which can help and ease symptoms. Why type of psoriasis do you have? Plaque or PPP? It sounds like PPP given you’re so distressed with it. Is it excessively itchy? Or is it just cracking and really sore? How are you managing it presently? Are you taking anti-histamines for the itch, what lotions and potions are you slathering yourself with? We can help further too if you can answer those questions.

As for a lack of sleep, that can make everything simply awful. You can buy histamine sleeping tablets over the counter in the USA (from memory) - have you tried any of them? They can be excellent. You can also get prescribed short courses of sleeping tablets which prehaps your doc should have prescribed instead of pred.

Both pred and mxt won’t cause an interaction with Talz either. Whilst I know it sounds stupid to keep taking Talz when it’s failing you, it will none the less be trying to do something so staying on it until you can get yourself to a more competent doctor is probably wise.

Getting yourself to a more competent doctor now muc become your sole priority seriously. You know that some people with severe psoriasis need to be treated as an in patient in hospital too. It’s the only way to get on top of it.

I hope this helps.

1 Like
6

Sounds like you’ve got a decent plan. It is 5mg of folic acid you take with mxt so double check they’ve prescribed the right amount and your primary care doctor can easily prescribe it at the right dose for you just anyway.

Watch that psoriasis as your own gut instinct that this is different for you shouldn’t be ignored. Can your primary care doctor biopsy it? Or do you have a decent dermatologist?

As a teen I was covered head to foot in plaque psoriasis two things I did which made it more comfortable. First I used an old fashioned cream called diprosalic which was decently greasy but kinder to the skin than any of the heavy duty steroid creams so it made it more comfortable and I used the Body Shop’s ginger shampoo on my head. Both helped.

Friends of mine dealing with psoriasis (mine fled in my 30’s when I badly fractured my shoulder) have their GP prescribe estillar foam (hope I’ve spelt that correctly) which again your primary care doctor can prescribe. Just some more ideas for you.

Hopefully the steroids help you and give you some respite for that week at least.

1 Like
7

So sorry to hear how bad things can get with Psoriasis. I can only tell you what I have tried and what works for me. If I am on the pred tablets I can’t sleep, I feel great and I become verablly aggressive and speak my mind rather than be tactful. Then there is the big crash reducing and going off pred. There is a pred cream you can use on your skin and after a few days I noticed improvement, mine is called Advantan and I did not have any side effects. The Advantan cream is non greasy and works well for me and after a few days I see improvement. Over a few months it cleared my skin. I also use Virgin Coconut Oil on my skin straight after a shower after gently towel drying myself. Coconut oil goes on greasy but soon absorbs into the skin and then is non greasy. If you can have a bath tie up a cupful of rolled oats into some muslin, or cheescloth or the foot of an old stocking and attach it to the tap, so the bath water runs over it. This can be very soothing to irritated skin. I also use a non greasy non perfumed moisturizer called Aveeno. Ask your pharmacist about a vitamin A cream that also helped me. I think if had vitamin B in it as well. It was called Bepanthan.
I still feel a bit sick in the gut and have to rush to the toilet the day after taking mtx. My rheumy halved the dose of 20 mg into two 10 mg tablets and I took it over two days with two days in between and two 5 mg the day after mtx. After few weeks I was able to take the 20 mg mtx on the one day. I still get a bit of a belly ache but I can live with it and it goes after an empty out in the toilet. After about 4 months my plaque psoriasis had almost cleared down to a few small patches. My inverse p improved. I went off the mtx and the plaque psorisis and the inverse came back worse than ever.
I am now using Topical Hemp Cream, the ingredients are Olive Oil, Bees Wax and Hemp Extract
This is by far the best on my Psoriasis. It removes the plaque and dries out the inverse P.
It works within hours. I can only use this every 2nd day as once the plaques come off the my sin feels very thin and my skin need time to recoup, which it does and in between I use the coconut oil. I am from Australia and I don’t know whether the names of my ointments and creams are the same as in the USA. Most importantly, check medication changes with your doctor/s.
I do hope that something I have said helps you and you see an improvement in your skin. Do you have scalp psoriasis as well? I do hope you are feeling much better real soon.

2 Likes
9

Tips for scalp plaque psoriasis. Witch Hazel and Vegetable Glycerine about half and half. OR Hemp Oil, or Coconut Oil. Put on a shower cap and sleep with on your head with your hair covered in oily stuff overnight.
I use Castile liquid soap to wash it out, then my usual shampoo and conditioner. Nuetragina makes a Coal Tar Shampoo and Conditioner also worked for me. I know how much all this mucking around it takes looking after our bodies and scalp along with coping with Psa. The MTX should help with the scalp as well.

I am taking MTX and have been on Xeljanz a Jax Inhibitor which has now been taken off the market due to it causing blood clots. Now I am waiting for Medicare to approve a different one which I am yet to find out how to spell it. My Rhuemy only verbalised it to me and I forgot to ask him to write it down. It sounded like Rinquin…

I do suffer from vasculitis now and again which causes me to get sores on my body. This mostly happens when I have to go off my medication either due to being ill because or I need some surgery.

1 Like
10

Hi Bella,

I bet your doctor meant Rinvoq as the other JAK inhibitor. It’s having decent results in the UK.

If your doctor increases folic acid to 5 mgs every day but mxt day, you might find the residual tummy issues with mxt might reduce further. Another tip is to seriously increase your water intake to around 3 litres per day the day before, the day of, and the day after taking mxt. Other tips for reducing that quesiness is ginger, and oddly salt and vinegar crisps (potato chips) too.

11

Honestly it’s the 5mg folic acid every day but mxt day will help a heck of a lot more than merely 1mg. Don’t know what online research you were accessing but here in the UK it’s perfectly acceptable to take 5mg of folic acid 6 days a week whilst on mxt. Best of luck.

12

I agree with @Poo_therapy, if taking mtx, 5mg/day folic acid is standard. My rheumy didn’t have me skip it on the day of taking mtx. He said it is debatable as to it being a problem taking it on the same day and that latest research gave little reason to skip a day. But go with your own rheumy’s advice. I was put on Rinvoq as a JAK inhibitor very close to the time xeljanz was taken off. Kind of makes me wonder when Rinvoq will be pulled for an “improved” version.

14

The irrefutable fact is that mxt depletes the normal folic acid you get from food etc in your body. Hence the reason for adding folic acid in when you take mxt. How people react to the toxicity of mxt (as it is cytoxic just anyway) differs from person to person. Some people have no tolerance to mxt regardless of how much folic acid they take, others do absolutely fine with just one 5mg of folic acid per week. Others need varying amount of folic acid from 2x5mg right up to 6x5mg per week. There’s loads of evidence out there that taking folic acid 6 days a week whilst taking mxt can limit yuccky side effects. It’s said to be a waste of the folic acid tablet if you take it on the day you take mxt since mxt depletes it. So why waste the tablet for no good reason.

And remember even when you’re not on mxt your folic acid can be reduced too. Following standard blood tests, and then more detailed blood they found my folic acid was low. So despite the fact I’m not on mxt at all I’m on a 3month course of 5mg of folic acid daily for the next 3 months. Then I have two months with no folic acid and repeat the specific folic acid blood test. And see what I’m like.I could end up on it for life. It’s not a biggie for me though.

My understanding of it in my case is that it’s probably due to the mild Crohn’s I have. Anyway it causes a type of anemia, which I’d rather not have. So adding in folic acid is just fine by me for now.

So have a low threshold for mxt side effects and seek to increase your folic acid if and when required. It won’t make any difference as to how well mxt works but it might help you feel better on a day to day basis.

1 Like
15

Hi Poo-Therapy.
I am sure it is Rinvoq. I have to wait about 3 weeks for the approval to come through from Medibank in Australia. I can only get subsidised medication if my blood work shows that the medication I am on is still working and with an explanation from my Rhuemy… So I have stopped the Xeljanz because my General Practicioner or as you in the USA call it your Primary Care Doctor said that my symptoms of losing some of my vision for only a few seconds sounded like a clot. Xeljanz is being taken off the market because it can cause clots. I will have to put up with whatever happens while I am waiting for the new JAK Inhibitor Rinvoq approval to arrive. I have discussed taking folic every day except MTX day with my Rhuemy as that is how I took it previously with a different Rhuemy before I moved interstate. My Rheumy was insistent that I take 2 x 5 mg the day after the MTX day. No explanation and I didn’t think to ask. I will talk to my GP. Thanks for the ginger tip, I don’t know why I didn’t think of using ginger.
It is the diorrhoea the day after the MTX which can last from a half a day to two days that I don’t like especially the belly aches.
I tried taking MTX twice a week with days in between, my Rhuemy does not want me to do that either.
There seems to be several ways on how folic acid can be taken.
Is there any benefits or harm in taking folic acid 6 days a week?

16

They say taking folic acid 6 days a week with mxt, lessens daily sort of side effects. I don’t think there is any harm in taking folic acid 6 days a week either. Folic acid in itself prevents different types of anaemia just anyway. I do hope the Rinvoq comes through soon for you. And just so you know I’m in the UK though, not the USA. Therefore always grateful for our NHS!

18

It’s not one I’ve tried so I’m of no use to you. But 4 weeks in on a med that can take time to reach full efficacy is possibly asking a lot. The mxt itself should start helping too but that also takes time.

20

I really don’t believe Tremfya is known for working that fast. If anything it’s a bit like Cosentyx which certainly can take its time to work. Remember unlike Humira which is an anti-TFNa one, Tremfya is another interleukin one so they operate differently to humira etc. My guess is that it will work faster on psoriasis rather than PsA just anyway.

21

Do physicians, especially rheumatologists have a method or system (science) for choosing what to prescribe next for PsA? Or are they choosing by what worked for someone else, which supplier requires the least paper work, or the cost considerations to the patient? At my last rheumy appointment, he handed me a pamphlet on Simponi on the way out the door and said to call him if I wanted to try it. No explanation as to Simpini vs Rinvoq, how Simponi works etc. Sometimes it appears that they have all the names of the various drugs in a hat and they grab one and prescribe it if it hasn’t been tried already. Sorry to be long but how do they choose for us?

22

In the UK there are general protocols on which meds are next. A lot depends on how well or how badly you reacted to the last one prescribed too.

But we would tend to try Enbrel or Humira first (having had two cDMARDS like mxt, sulfaslazine, or leflunomide fail us plus have at least three affected joints on a PsARC exam - if that hasn’t happened the rheumy won’t get any biologic funding for you) both by biosimilars so a lot cheaper than the original. If one didn’t work we would then try the other.

Depending on how you did with these anti-TFNa strata of meds you might then try something like Simponi or indeed Cimzia. Cimzia is also used for females who want to continue to grow their families as it’s safe in preganancy.

If like me the enbrel and humira meds did diddly squat you move on to the interleukin ones like Cosentyx, Talz, Stelera, Tremfya fairly rapidly.

Again depending on how you react to them you then hit things like the JAK inhibitors and Rinvoq etc.

It’s a sort of general protocol but of course isn’t that rigid and much depends on how the patient responds either positively or negatively.Or indeed how active or not the disease activity is plus of course its progression.

Many of us will just bounce around in lots of pain when a med doesn’t work for us without too much actual damage being caused. Others of us will also get fast occuring damage happening at the same time, I’m generally the former thankfully as when you’re one of the latter, things can get quite serious extremely fast.

There are at least 5 different types of PsA too but rarely do they distinguish the types because it doesn’t really matter that much, the treatment available invariably is the same. But the fast damage causing PsA is called PsA Mutalins (spelling?) where your joints can literally deform over night and your tendons start califying etc.

I’m so sorry you have such a miserable lack of information from your rheumy @Amos as to the plan for you, other than requiring you to spend money on podiatrists and carpal tunnel specialists. Most rheumys do have a plan or have to follow some sort of protocol which kind of helps sets expectations better.

But remember we have a very illogical and irrational disease too so it’s not always as easy as plodding through from A to Z either. There are lots of time when they just make the best guess as to what should be next which should hopefully be borne out of experience.

If only the science would just hurry up at knowing which meds would suit which patient, then things would hopefully be a lot more simple. They are making huge strides with that on cancer treatment. It will take time to filter down to the likes of us sadly.

2 Likes
24

I can’t say that MTX did anything for my PsA or psoriasis and what I thought was PsA brain fog and fatigue actually went away once I quit MTX and just went with the biologic alone. It is important to take folic acid pills everyday. My rheumy was of the the theory that there is no need to stop taking folic acid on the day of MTX but others want you to on that day.

26

You should be fine. Drink at least 2 to 3 litres of water the day before the day of and the day after taking mxt. It’s helps flush it through and helps to minimise side effects.

Max dose of mxt for PsA is 25mg, max dose for psoriasis can be up to 30mg. In the big scheme of things mxt wise it’s actually a low dose. Sadly for some of us me included my body hated mxt even at 10mg. But since you’ve done ok on that, my guess is you should be OK. The upping of the water intake really does work.

There is no point of taking folic acid on the day you take mxt as mxt leaches out the folic acid so in effect you’re simply wasting a tablet for no good reason. I do hope it helps you.

1 Like