After waiting more than a month for an appointment, I finally got to see my new Rheumy today. I am happy to say he was worth the wait. He spent an hour with me discussing, explaining and examining me. He even did an ultra sound of my Achilles Tendon right there on the spot. The first doctor I saw spent less than ten minutes with me and did not even touch me. The diagnosis was the same…PsA. But my new doc took the time to list why he believed it was so and also discussed some symptoms I have that are actually other types of arthritis. I have Severe Degenerative Disc Disease as well as Osteoarthritis. Right from his office he sent me to the radiology department at the hospital for x-rays of my sacrolliac joints and my neck. He is having me start on Methotrexate this week and I will start on 4 pills and build up to 6 over the next three weeks. Then blood work and back in for another visit. He also prescribed Folic Acid. To say I am scared is an understatement. I have had blood work prior to all this where my liver numbers were bordering on Fatty Liver Disease so this freaks me out. But not as much as ignoring it does. I hope it works and I tolerate it well. I considered waiting till the New Year to start treatment but didn’t want to put it off any longer. I am sure I will be leaning on every one for advice. I work full time Monday-Friday so I thought I would either make Friday morning or Thursday night my night to take my Meds so by the time it kicks in I home in case there are side effects. Any thoughts on which would work better?
Glad your new rheumy was worth the wait! A good dr. is worth their weight in gold.
I did Saturday injections when I first started. Onc I realized that I didn’t get any side effects, I changed my day to one that fits my schedule better. I picked Saturdays so that I could have half of the weekend to do what I wanted. Also, Sundays are typically our down day of the week, and we don’t schedule much for then. From what others say, side effects usually last 24 hours, so that would give you plenty of time to recover before work.
Don’t worry until you have to. The doc I’ll watch your labs to make sure that you aren’t having problems. Let them worry about your liver for you.
So glad to hear that you have a good doctor. Count this as a very good day. 
Hi Sunsettersdottie - I am also on methotrexate and folic acid and I found that I feel tired from it (may have been coincidence as I find it difficult to understand/remember my body sometimes) so I simply take it on Friday and Saturday instead so it doesn't effect my monday/tuesdays in work. It seems to have worked, so find out what suits you and persevere or pre-empt it and go for Friday and Saturday.
Hope all goes well with you. I have been so lucky with my rheumatologist and rheumatologist nursing staff - really excellent.
I'm so glad you have a new doctor who really seems to care and listens to his patients. That is a wonderful thing. Don't worry too much about the MTX. Some folks don't do well with it at all, but others don't have any problems. It all depends on how the medicine affects you. I would recommend taking it (at least the first time) on a weekend when you don't have to work for a couple of days. I take mine on Sunday nights, but that's because I take Enbrel on Wednesdays and Saturdays and I don't want to do Enbrel and MTX on the same day. I'm also not working, so it doesn't really matter when I take it (though I do have to get up weekday mornings to take my son to school). I've followed this dosing schedule for quite awhile now, with no major complications.
I used to take MTX - was on it for about 2 years, I guess - then Arava, but am off both of them now. I was taking 10 tabs of MTX at the time and had NO side affects at all. I did not tolerate Arava so well. My Rheumy has me switching off Humira to Orencia next month. (I have been taking Humria at the highest dose of once a week for awhile now.) He wants me to have no stiffness and feel like I'm 25! HA! Wouldn't that be wonderful?
My experience with methotrexate was not good. To start methotrexate is a very powerful drug for cancer and made me feel so sick . I know they prescribe it for PSA but it did nothing for me.other than make me feel so sick very flu like .
I started Embrel after the methotrexate didn’t work and had great results. Without Embrel I would probably not be able to walk.
Hope you feel better…
The dosage for use in cancer patients is like 100 times the dose for PsA so I wouldn't freak out about it. What works for some won't work for others. We are lucky that we have so many drug options available to us now. I would rather be on drugs and walking around than be stuck in bed or a wheelchair from PsA.
John Mac. said:
My experience with methotrexate was not good. To start methotrexate is a very powerful drug for cancer and made me feel so sick . I know they prescribe it for PSA but it did nothing for me.other than make me feel so sick very flu like .
I started Embrel after the methotrexate didn't work and had great results. Without Embrel I would probably not be able to walk.
Hope you feel better..
Glad you are jumping to to treatment but sorry you have to.
Keep in mind the reports you see tend to be those which include problems for the people reporting it here and for more outstanding successes. The more every day experiences often go unreported. MTX (methotrexate) is most often the first medication prescribed and it is my present belief the vast majority of us experience no side effects or short/low level side effects. I am a senior citizen and had no side effects the first time or since - almost a year now.
Some have some pain or other side effects from injecting biologics and yet others do not. I look forward to my medications - both oral and injections as they are my life line to feeling alive and not a repository for pain, depression and limitations.
While you fear the unknown (and who doesn't) think of taking your new medication as you would an antibiotic - you may not have taken it before but you don't get too worked up over the idea either.
John Mac- It made me sick too! Everyone is different, though. I got to the point I would throw up just looking at the greennliquidbint he vial! Lol! And we had some hand soap the same color - it made me sick to look at that soap. Ughhhhhh!! My rheumy stopped it and said he could use something else. Good thing because I was ab to go on strike. Some people have no reactions, though. And my doc is the best!! He assured me that mtx is super safe and even does things like prevents heart attacks. It is just some people can’t tolerate it.
That is the same thing my doctor did, she spent a lot of time with me, sent me for chest X-ray right after seeing her and started me on methotrexate, 4 pills one time a week, folic acid, and calcium pills. I was scared to death to start it, did for the first time last Saturday morning by late afternoon I was nauseated, had a headache when I woke up that morning so it wasn’t the medication. Started feeling better late Sunday morning. I hate the fact I got this. I’m still on prednisone, 1 pill and a half. Last week I was cleaning my yard and picked up something heavy with my left arm and now it feels like my right arm does which is from this disease.
Sounds like you have a good caring doctor. That goes a long way. Way back my treatment started with oral Methotrexate as well. My rheumy asks all his patients to take it on a Monday ..... 'm' being for methotrexate and monday ...... but it was wiping me out and I couldn't function the next day or day after so I changed to Friday night so that I had help from my husband in my business and at home over the weekend when I felt rough. It didn't ever agree with or work for me, not even once they switched me to injections. That is just me, though, for lots of people it works just fine and increasing your folic acid dose (on your doctors advice) can help if you do get nausea.
I agree with everyone else, initially it is daunting to take all these drugs, but when they work they can transform how you feel and with regular blood tests the doctors keep a really close eye on your liver function and other stuff so that any problems are picked up early.Good luck with whichever day you choose to start and remember you can always change days if you need to.
Dear Sunsetterlottie, don’t be afraid of the Methotrexate, but don’t take Folic Acid on the same day. I would take it Thursday night if I were you, it can make you feel a little nauseous sometimes. My PSA was picked up early, I was put on Methotrexate, Salazopyrin & Prednisone straight away &I believe those drugs have helped put this awful disease into remission for the past couple of years (I’m touching wood. I also believe in quality over quantity, I can’t be a functioning, wife, employee or friend when I’m in agony. I’m rather fatalistic in that respect, there again I’m older than you too. Good luck with it I’ll be interested to know. Lorraine
I am so pleased that you have a new rheumy, have been xrayed and are on new meds.
I take my Methotrexate on a Tues night and I don’t plan activities for Wed, unless I have my Stemetil to stop the nausea.
Congrats again on getting a great rheumy.
I take 1 mg folic acid daily, and 7 methotrexate on Sundays. Your doctor may ask you to take it differently, but again, I have very little trouble with the MTX. General fatigue, but that might just be from the PsA, not the MTX. Hard to know.
Dear Sunsetterlottie, I was started with methotrexate injections, at the doctors office on Friday am, by 5pm I was really tired. I eventually was given the shots with Humera. Folic Acid, b complex, naproxin, vitiam D. I would take the pills on Friday afternoon or when you get home on Friday evening. That way the fatigue and upset stomach is during the time you can sleep and rest. Of course over the years stress, fatigue, have given way to fybromyalgia, and osteoperosis and other types of arthritis. I am glad to hear you have a good doctors, he sounds like he through. That is good.
Debra
I don't take methotrexate because the side effects were too much for me. Many people take it with no problem. Alsot many people say that injecting the med has less side effects. GrumpyCat injects. Good luck! Did your doc talk about biologics?
I'm so glad you found a good rheumy it really helps your mental well-being when you have a good doc!