Methotrexate vs Arava for fatigue and brain fog side effects

Hi there,

I am interested in hearing from anyone who has swapped from MTX to Arava and if they noticed a difference in fatigue and brain fog?

I was only recently diagnosed with PsA and have been taking MTX for 3 months. Since I started it I have had a very strong reaction to it. In particular the fatigue has been destroying my life.

Before I started it I had bouts of Fatigue but since taking it my whole life is a blur of exhaustion. I have 3 small children and I work full time. I run my own business and have staff so i am not in a position to take a step back but have been bed ridden regularly in the last 3 months. I can barely care for myself let alone my children. I am struggling to run my business.

The other nightmare has been my memory. It is like a sieve. I can not retain information and I can not think complicated thoughts. Even simple ones some days.

My PsA has also been getting worse, so I am a bit unsure as to whether it is the drug or the disease making the most impact.

I have brought this up with my Rhummy of course and although I dont think he really comprehends how completely the fatigue is ruining me, he has suggested swapping MTX for Arava.

I now have a concern that it as taken me 3 months to get used to this awful drug, whether I will get any different effects on fatigue or memory taking Arava which has its own list of hideous side effects.

Has anyone swapped between these two and noticed any improvement?

Thanks in advance, yours truly exhausted mess

Yes, I made this switch for pretty much the same reason ... and the mtx wasn't helping with my joint pain either. I found the Arava (leflunomide) much more tolerable and as best I recall it was about 7 weeks before I began to notice improvement in my PsA symptoms. My psoriasis cleared up completely. I had many months of joint pain relief and then it started creeping back. My dose was increased and it was only at that point I started to develop side effects (skin rash/bruising, itching and some numbness on my forearms) and eventually had to stop taking it. But I definitely didn't have the fatigue or brain fog with Arava that I had with mtx or uncontrolled PsA.

Oh Thank you Jules! Sorry to hear it stopped working but very glad you noticed a reduction in fatigue. That is very encouraging. Your reply is much appreciated

I have a lot of trouble with fatigue even when I am technically well controlled. That said, I did switch from mix to Arava. The mtx was doing nothing for me other than making me feel morning sick all of the time.

I did have some side effects with Arava when I switched, gi side effects. We lowered my dose for a few months or so and then increased back up with no renewal of that side effect.

I took MTX for 10 miserable months. I’ve been on Leflunomide 20mg dose for 7 months now and I feel so much better than I did on MTX. It did take about 3-4 months for the maximum relief. MTX just sucked the life out of me. My family notices how much better I feel since the switch. Leflunomide works so much better for me. I have about 50% less joint pain. My fatigue is more manageable and brain fog is better.

I hope you get good results if you decide to make the change!

This is a great question. I’ve been on mtx for over 2 yrs and still suffer from fatigue. The day after mtx is the worst. I lay in bed all day taking naps. I don’t have any energy. Last week I did 1 load of laundry and I over exerted myself. I flared up the next day. I learned my lesson. Today I’m resting all day and will do laundry tomorrow. Eager to hear other experiences.

My first thought on reading your post is that Mtx may not be working for you. Although you say that as well as the fatigue, your PsA is getting worse, my experience of untreated PsA was that fatigue was the number one symptom. (Although there were quite a few number one symptoms - how to choose which is worst?). And there was a point at which it went from awful to all-encompassing. So could be that the 2 things, starting Mtx and PsA fatigue hitting the roof, happened to coincide.

3 months is so often the magic timescale with the DMARDs, that's about the point at which you'd expect to see improvement if there's going to be any. Some rheumys seem to expect another month or so of 'wait & see' though.

Response to drugs and side effects from drugs are so incredibly variable and clearly Arava works better than Mtx for some of us. However I seem to be able to take just about any drug without any side effects that are perceptible to me but the one exception was Arava. Nothing awful happened, I just felt out of sorts compared to feeling okay on Mtx. But Mtx, Sulfasalazine and Arava all failed to put my disease in its place good and proper. Sooo, I reckon there are quite a few reasons stacking up for trying Arava .... and one important one is that if you've tried 2 DMARDs without success your rheumy may consider a biologic. For so many of us it's the bio that is finally the game changer.

I think, go for it. I hope it works but even if not you might be that much closer to something that will. And I think you need to work on that rheumy. Does he really not understand the impact of fatigue, do you think? Or is he a very good rheumy with a rubbish 'bedside manner'? If it's the latter that could be just fine but I'd worry about the former.

I bet you know this but Arava is that bit harder on the liver than Mtx. I think it's best to avoid alcohol altogether while taking it.