Newbie wondering if people manage by taking Methotrexate alone

I have had Psoriatic arthritis for two years and so far have been managing by taking Methotrexate and the occasional panadol.A good nights sleep helps me too.

My question is are there people out there that have managed by just using Methotrexate long term or is a progression from MTX first and when that stops working you go on biologics?

Here is Australia we have to try Methotrexate first and at it strongest dose and if that fails then we may be able to go onto a biologic but it seems to me that most posts I read people are on a biologic.They are not advertised on TV over here so maybe that is why they are not as widely used or written about.Plus MTX is a lot cheaper and maybe the government want to save money as a Biologic is expensive and subsided here.

What is peoples experience?

I am thinking it is only early days for me but am hoping I got it early and can manage without any deterioration as I am hoping MTX will stop any damage occuring.X rays show no damage so far and I only go to the Rhuemy every six months but would go if anything changes sooner.

I suspect I have had PA longer than two years as just used to go to a physio when sore and she manipulated me but when my hands started swelling and I kept dropping things I new something else was up. Cheers everyone.

I am also a newbee here, but from what I gather most people take a combination of different meds along with MTX later after trying by itself. Sounds like it is good for relief of certain symptoms! My experience was my Rheumy said that most insurances and mine for sure wouldn’t approve the use of Biologics before MTX so we have to try it for at least 6 mths. Rheumy told me that, after I was very blunt about not wanting to waist time on MTX if perhaps Biologics are the most effective in PsA treatment. I for one would not like to find out that while I try inexpensive treatment my bones deteriorate:( even more! What can you do, thats HMO way! Dont get me wrong though I will still be hopeful and pray that this is a good treatment for me without S/E of this drug. So thats my version of things here in CA. Goodluck to you!!!

I started on MTX alone & escalated to maximum dose without any relief. So then rheumy put me on a biologic with MTX. Insurance required trying MTX alone first. In my case, there simply was no question. MTX alone did nothing for me. Eventually I had a reaction to the MTX. I am now in a biologic only, no MTX.

There is also combination therapy, where you might use 2 DMARDs. For example, I failed on MTX, but then did relatively well on leflunomide when it was added to Plaquenil, which I was still on, along with an NSAID. I was not on a biologic for the first 6+ years post diagnosis.

Biologics are horribly expensive, and whether you have socialized medicine or private insurance, you typically have to fail some DMARDs prior to going on a biologic. The only time that seems to not be the case is when diagnosis happens late in the game, and more drastic treatment is required.

Like Stoney says, there are all kinds of combinations of DMARDs which people do find help. You can live with this disease for a long time, using only DMARD therapy. Not everyone has disease that progresses: that’s why you need to have regular checks with your rheumy.

Here’s a really interesting link for you, which gives some insight into how Australian rheumatologists approach the treatment of PsA. I’m impressed –

http://www.rheumatology.org.au/downloads/FINAL-BiologicalRecommenda…

They make a point of mentioning that their guidelines don’t quite square with the government guidelines. –

http://www.medicareaustralia.gov.au/provider/pbs/drugs1/files/4158-…

Very interesting.


Wow.I am impressed too didn't know that information was out there. Thanks!

I could actually understand what was written which is great.

They do give out a good hand out about Methotrexate when you start taking it so figures that they had one on Biologics.Just didn't know where to look.Made me feel better knowing what is in there and the procedure.
Seenie said:

Like Stoney says, there are all kinds of combinations of DMARDs which people do find help. You can live with this disease for a long time, using only DMARD therapy. Not everyone has disease that progresses: that's why you need to have regular checks with your rheumy.
Here's a really interesting link for you, which gives some insight into how Australian rheumatologists approach the treatment of PsA. I'm impressed --
http://www.rheumatology.org.au/downloads/FINAL-BiologicalRecommenda...
They make a point of mentioning that their guidelines don't quite square with the government guidelines. --
http://www.medicareaustralia.gov.au/provider/pbs/drugs1/files/4158-...
Very interesting.

There are certainly people who do manage on conventional DMARDS (methotrexate included) for a great many years. There are a few on this forum who had this experience before changing to biologics, and with any hope, you will too.

I'm in Australia too - and the medicare guidelines, hoops you have to jump through, etc to get biologics seem so very convoluted and difficult it will never happen. Bear in mind that many people on this forum have more severe disease than average, or haven't yet found a treatment that works (that's why we are here), so there is probably an over-representation of biologics users (as well as the predominance of USA members - and their system is so very different from ours).

I didn't get any significant relief from MTX (maybe 10% in my hands, nothing in my feet, knees, hips, shoulders or spine, and nada in the way of fatigue relief). I had very sudden noticeable onset (from taking life at 100mph at age 36 to "I wonder if I'll need a wheelchair next week) in a 6 week period, had very little response to any other DMARDs, so I had a very strong vested interest and opinion on Biologics, given the results that are noted for PsA patients,

But what I did learn, from an Aus point of view, is that it is very possible your rheumy won't be in favour (mine wasn't - but is wasn't anything to do with cost, and everything to do with his fear of side-effects). And what I also learnt, is that you can most certainly ensure that the system does the right thing for you - as long as you can convince your rhuemy it is what you want, need, and are willing to take the risk on.

Certainly the biologics have a better record for preventing actual joint damage than MTX in all the double blind, blah blah... (feel free to come in and correct me Lamb). But if you have effective treatment with MTX, and you've got a rhuemy who is monitoring you for damage in a proactive way...... well I'd be very happy with that!

BTW Seenie - I don't actually know who wrote that guideline on the approach to PsA for Australian rhuematologists. Because I sure as heck haven't found one rheumatologist that practices it. Way back when I thought my life was ending (aka onset), I even emailed Nash (of Gladman and Nash), and he was prompt, compassionate and courteous in his response. But he told me that MTX was by far the best, and he wouldn't recommend any of the biologics, because of the risk. He has a family member with PsA who manages very well on MTX. He was so very compassionate, but in Australia, there is still that issue that the doctor is considered to have better decision making skills than the patient, and their focus is entirely keeping you alive - quality of life doesn't appear to be a strong contender.

How interesting, Jen, to compare your real-life experience to the guidelines. I would have guessed that a prof of rheumatology at QLD would have a somewhat more progressive approach than you got. I wonder if he was just doing his collegial support routine for your rheumie?
The difference between guidelines, policy and what actually happens with patients is interesting, isn’t it?
Do tell, though, how, despite the prevailing attitudes you encountered, you managed to find someone who was willing to give you the Biologic treatment that turned you around and gave you your life back.

The most difficult rule of life for me to learn (an may not quite fit here) is"

"Don't fix what ain't broke"

The US numbers are much higher for use of biologics but as a point of reference: only 26%of patients use Bios Patients who initiated biologics both as monotherapy (30%) and in combination with methotrexate (36%) dropped the therapy with in 12 mos and 50% dropped all therapy.

So no matter how you cut it basically only 1 in 5-10 patients use Biologics. As was said earlier people here generally have severe disease.

Thanks for the statistics.Wonder what happens to the 50% that drops all treatment.

I guess I am lucky as I must only have PA mild or got it early and have managed it pretty well.

To all those chronic sufferers hope you can get some relief soon.Good luck.

I wondered that too. I guess they just limp along and take NSAIDs and tylenol/paracetamol. I guess if your disease is mild, the treatment can be worse than the symptoms.

Good to know Anna.I hope MTX works for a few years for me too.