Newbie post - realistic expectations for MTX

Having been diagnosed with PsA about a year ago, my relatively mild symptoms responded well to MTX. Since the new year, however, I have developed dactylitis in another toe and this is more uncomfortable/painful than last time round. I had hoped, perhaps naively, that the drug would keep additional symptoms at bay. Should I be adjusting my expectations? Should MTX eventually bring the new symptoms under control?

Thanks all

I’m not sure that anyone can predict what will happen if you stick with the same treatment. But I’d imagine that the appearance of more dactylitis suggests that Mtx isn’t helping enough.

I think it’s really helpful to have confidence in treatment, up to a point anyway. I suspect that determination that drugs WILL work has helped me, though I can’t prove it of course. But yes, it could well be time to adjust the expectations. Don’t throw the baby out with the bath water though - it’s great that Mtx has helped so much, another drug might help even more so I reckon you’re doing pretty well!

When do you next have a rheumy appointment? I see you’re in the UK, so the next step may be to either try another DMARD as well as Mtx, or instead of it.

Many thanks for the reply. I will see my rheumy again in the summer. These latest symptoms were only just starting to develop when I last saw my consultant and so now it’s a question of wait and see what happens. I’m hopeful that the MTX will start to do their thing sometime soon - in fact there are already some small signs of that. I remain optimistic.

My response is an attempt to create a big picture concept rather than any one medication issue. No one medication can be expected to do everything. MTX can help - especially with inflammation but not to stop progression of PsA. What MTX does it usually does well but it does not address all aspects of PsA. DMRDS address but most don’t get that much relief different aspects of the condition which does help to slow progression - but keep in mind that it will not totally stop progression, but slow it. Possibly a small percentage of patients might see what looks like a complete remission. It is also possible that you started MTX in an early phase of the condition which has since ramped up and surpassed the early impact of MTX. Be patient and bob and weave with this monster - PsA.

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Thank you for such an informative reply. I was under the impression from my rheumatologist that MTX would act as an effective preventative measure so I will quiz him about this on my next visit. It has certainly been helpful and I have had no side effects from taking this drug. What I am beginning to understand, particularly from reading posts in this group, is that PsA is indeed a monster and so far my symptoms have been relatively mild. I just hope it stays that way.

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I know this is older but glad Methotrexate was working somewhat for you with no side effects… curious if you’ve seen your Dr. And what route you’re taking now.


I’ll be seeing my rheumatologist in a couple of weeks. Still on MTX as before and it seems to be doing its job. The dactylitis in one of my toes has settled down since the start of the year and no longer causes any pain but I have yet to ask my doc about the longer term picture and the likelihood of future digits swelling up given my current treatment. Having been on the Psa list for a while, I realise that my symptoms are mild but very much hope they stay that way.