Pneumonia and ready to stop methotrexate

General
1

I am ready to stop my methotrexate for good and just wanted some advice. :( I have taken the methotrexate for 4 weeks and developed pneumonia this past week. The infection started as a sinus infection and then progressed quickly into pneumonia. I have always been very healthy. I asked my PCP if the methotrexate could be the cause of the illness progressing into the pneumonia so quickly because I had been told it weakens your immune system and she said yes. She has my methotrexate on hold while I take antibiotics, prednisone etc. but I am not sure I want to continue a med. that weakens my immunity this much. Does anyone else manage their Psa with other type medications that do not cause a weakened immune system. I am a nurse and I am incontact with illnesses every day. I am feeling very low and and had such high hopes that the methotrexate would help the pain, but the side effects are scary. Please give advice, I am not sure what to do.

2

I agree with mimiB. Take the meds.

3

I've been on mtx for about 7 years. I have not caught most of the crud in my own family. I've not even missed work due to flu, cold, infection, and I work around sick people. You may have gotten pneumonia with or without mtx. If the mtx is helping, don't right it off. I wish you a speedy recovery. I am adding enbrel to my med list tomorrow, and I am ok with that. I've talked to my dr., there's a nurse support line thru enbrel, and the people here have calmed my worries.

4

Yep that’s true, I have my vaccinations for flu each year and the pneumonia one is every 5 years I think…that’s in the UK anyway. Please think very carefully about stopping meds, knee jerk reactions are often the cause of a lot of pain, speak to your specialists first before you make any decision, I’m a front line NHS worker and have rarely caught anything from my poorly patients and I am on MTX too. Good luck

5

I am a nurse too and was on MTX for 3 years. I was very fortunate with not getting anything out of the norm. I guess I was just super careful about wearing a mask with coughing patients and never touch my face at work. You have the right to wear a mask at work especially with so many people going unvaccinated these days (pertusis cases in ND are rising at a scary rate). I agree with getting yourself a pneumonia shot also. I get flu shots every year. And there are things you can do while on MTX to boost your immune system such as Probiotics.

6

Sorry you are ill. Flu & pneumonia shots are mandatory with my rheumy. I seriously recommend you do NOT stop your MTX. The risks of having no meds to control the PsA can be very severe & the damage done can not be reversed. Ask you rheumy about ful & pneumonia shots. Hope you are feeling better soon. HUGS....

7

Thank you all sooooo much for your input. I feel better just knowing this is not necessarily a result of the medications as you all have not experienced it. Just the right timing to scare me to pieces. LOL. I have my follow up with my Rheumy on friday and will enter with a different agenda after talking with all of you. I have been better with the medication except my mind and body are having to adjust to a slow schedule the first 3-4 days of the medication. Again thank you for your input and support.

8

Please don't stop the medication until you talk to the doctor who prescribed it. My doctor warned me that if I did develope any type of infection that the first thing other doctors would say is that it was caused by the methotrexate. Easy out for them.

9

No, you do not. While on Rx that weakens your immune system, not only can't you take vaccinations, nor be around people who had one. I take my meds but stay away from sick people. Yep, I stopped teaching Kindergarten because the kids would wipe their noses on my clothes while hugging. You keep the immunity you have developed throughout the years which protect you now from illnesses. Any new bug puts your life in jeopardy (includes vaccines with live bugs).

Stay on meds, stay off sick people and vaccinations.

lastshooter said:

You can also take vaccinations for pneumonia and flu. Speak with your doc on how and when.

10

I wasnt able to tolerate Methtrxte, but have been on Remicade, Humira and now Enbrel. All lower immunity and I have had infections. I try to protect myself and stop injections when I am sick so ai can fight the infection. Staying in contact with Docs is a must!!!

11

I have to agree with the folks who say stay with it. The permanent damage is not worth it. There are even scarier meds out there - methetrexate is a lesser evil. You will learn how to manage your health and risks. As a nurse you already know about washing hands - but you can strengthen your body with foods that make severe illness less frequent.

good luck

12

There is probably MORE misinformation about vaccines than anything out there. You can, not take live vaccines true enough (they were essentially developed for needle phobic wimps anyway) but the rest are just fine. Yes you MAY get more illnesses because of the drugs BUT statistically its not that much higher than normal folks and less than a first year teacher..... Remember this disease is caused by an OVER active immune system, all the drugs do is suppress ONE portion of the system.

Now we may get a few more minor bugs but every study has born out the incidence of SERIOUS infection is NO HIGHER with these drugs than without.

Now lets talk about your PCP.... As Nora pointed out, Docs that don't know what they are doing will blame the MTX. you are on a LOW dose not a chemo load. Beyond that The PREDI that she kept you on is FAR MORE LIKLEY to have been the cause (if any of your drugs were) than the MTX but now you may set back your treatment (and increase your pain levels) for several months while the MTX goes back to work or gets started. I don't mean to be dramatic. but I HONESTLY would sooner have Pneumonia, than PsA .........

1 Like
13

I am RN also, I could not tolerate mtx .I felt sick the while time on it which was 3 months. I am now on embral…all drugs has risk and affect everybody differently. Just keep working with MD to get the right combination

14

Immunizations are made from either "killed" or "live" viruses. You can take any vaccine from a "killed" virus, but not a "live" virus. In fact, your Rheumatologist should insist you get these vaccines! The pneumonia and flu vaccines are both "killed", so you can take both of them. I am on Enbrel, and the only vaccine I haven't been able to take is the typhoid vaccine (which was recommended because I was going to a Haiti), because it is "live". (There is a "killed" oral version but my doc couldn't find it) MOST vaccines are "killed". I have never gotten ill from an immunization, and I am rarely sick.

15

It could be a coincidence as well that you developed pneumonia. I tried everything before giving into Enbrel and MTX but I have been on them for years now and am just very careful. Get the vaccines everyone mentioned and wash a lot. It's what you have to consider in the long run really plus next time you get sick most likely you will be quicker to respond to the possibilities. That's the way it works for me now I do not wait to go to the doctor and they usually put me on antibiotics. I hope you are feeling a little better now.

16

MTX does weaken the immune system but my rheum tells me to stay on my MTX even while sick even Humira. I did go off humira because of a bowel and bladder infection in the spring. I was off for 5 weeks. Took 6 weeks and a steriod shot to get back on track with Humira. Personal choice. I have not had one cold or upper respiritory infection in the 15 months of being on Humira. good luck I hope you get well soon

17

The biologics are a lot more effective and a lot safer in terms of infections. For example, MTX doubles a person's risk of infection whereas Enbrel either increases it slightly or doesn't increase it at all.


A new study, with a link to it on the psoriasis.org says that MTX does nothing for psoriatic arthritis. Ask about going off the MTX and onto a biologic.

18

http://psoriasis.org/news/news-methotrexate-questioned-for-psoriatic-arthritis-

Methotrexate may be useless for PsA. Even worse, according to the DAA psoriasis practice guidelines joint damage can occur for patients on MTX even if the PsA seems to be controlled.

19

I have a differant opinion, but we all do..Methotrexate has been used since 1980. It's such a low dose to chemo for cancer patients. Enbrel came available in 1999?

Methotrexate works well for me, if i don't have it, i get the worse pain. Along with a biologic they work well with each other.Rheummy #6, I fired..i saw him for my scheduled appt, was taking Levaquin, for a bad sinus infection...This was 1997, I will never ever forget it......Pnuemonia can KILL YOU....

I told him i was on a antiobiotic, it's a strong one..He usually checked my breathing, most rheummies, are internal meds first.

I asked him, should i take my mtx and my Humira ( 5 yrs on it)....and he said his feeligns were, as long as i didn't have pnuemonia, take it

WRONG, BAD ADVICE..I got pnuemonia..I didn't know who was President, or what day it was. That sick, not eating. My neighbor is a nurse, and other neighbor is a cop, who had a paramedic friend visiting him...They came over, checked my vitals. I fought it, i was outta it..They threw me in a car, i got admitted...In ICU..for Easter

I had Left upper lung problems...After 24 hours in ICU...New rheummy came to visit me....PCP asked who the old rheummy was, and called him and chewed him out, told him why did u tell her ok to take HUMIRA/MTX

after ICU..ur in a glass room, they watch every move u make..then i was in isolation, 5 days in hospital...3 days of sputum testing, that came back ok, no TB

I'm not sure Biologics are safer than Mtx...but i DO KNOW, any inkling of a sinus infection, or anything not right, i get off the mtx or biologic..Now i am on Remicade, so it will be differant..I will delay an infusion, if sick

I stay away from ppl coughing, as best as i can..Am careful, haven't gotten that sick again. Or i go to the doctor, first sign

Also, i believe i got that bad sinus infection from a plane. Son was in the Army, had to transfer planes in Atlanta, Delta..outside..to a smaller plane to airport, near Ft.Polk, Louisiana, ALexandria i believe....People were couching behind me, on the plane

20

Here is why i disagree,....Methotrexate has been around a longer time. I'm not knockign biologics, been on them, 12 yrs...triple DMARD/NSAID/Prednisone before that....I would take 40mg prednisone again, if i couldn't lift my arm to shower, etc....that is a dangerous med too.. Enbrel was my miracle, when they gave it to me in2000. We had to try a DMARD first..And no alcohol

see what it says for MTX?..all med have side effects...taking MEGA_ doses of Aspirin, decades back would have killed your stomach, but what did they have then, compared to today?..not much, gold shots...nothing like todays meds

I'm glad i take my Biologic and Mtx..and am not in a wheelchair

WARNING

SERIOUS INFECTIONS AND MALIGNANCIES

SERIOUS INFECTIONS

Patients treated with Enbrel are at increased risk for developing serious infections that may lead to hospitalization or death [see WARNINGS AND PRECAUTIONS and ADVERSE REACTIONS]. Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids.

Enbrel should be discontinued if a patient develops a serious infection or sepsis.

Reported infections include:

  • Active tuberculosis, including reactivation of latent tuberculosis. Patients with tuberculosis have frequently presented with disseminated or extrapulmonary disease. Patients should be tested for latent tuberculosis before Enbrel use and during therapy. Treatment for latent infection should be initiated prior to Enbrel use.
  • Invasive fungal infections, including histoplasmosis, coccidioidomycosis, candidiasis, aspergillosis, blastomycosis, and pneumocystosis. Patients with histoplasmosis or other invasive fungal infections may present with disseminated, rather than localized, disease. Antigen and antibody testing for histoplasmosis may be negative in some patients with active infection. Empiric anti-fungal therapy should be considered in patients at risk for invasive fungal infections who develop severe systemic illness.
  • Bacterial, viral, and other infections due to opportunistic pathogens.

The risks and benefits of treatment with Enbrel should be carefully considered prior to initiating therapy in patients with chronic or recurrent infection.

Patients should be closely monitored for the development of signs and symptoms of infection during and after treatment with Enbrel, including the possible development of tuberculosis in patients who tested negative for latent tuberculosis infection prior to initiating therapy.

MALIGNANCIES

Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with TNF blockers, including Enbrel.t

Methotrexate

Applies to: injection

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Methotrexate:

Dizziness; drowsiness; general body discomfort; headache; loss of appetite; mild hair loss; mild sore throat; mild stomach pain; nausea; tiredness.

Seek medical attention right away if any of these SEVERE side effects occur when using Methotrexate:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); back pain; black or bloody stools; blood in the urine; bone pain; calf or leg pain, redness, swelling, or tenderness; change in amount of urine produced; chest pain; confusion; coughing up blood; diarrhea or vomiting; difficult or painful urination; dry cough;enlargement of the breasts (in males); fainting; fever, chills, or persistent sore throat; menstrual changes; mental or mood changes; mouth or tongue sores or swelling; muscle weakness; night sweats; one-sided weakness; red, swollen, blistered, or peeling skin; seizures; severe or persistent headache, drowsiness, dizziness, or light-headedness; shortness of breath; speech changes; swollen glands; symptoms of liver problems (eg, dark urine, pale stools, persistent loss of appetite, severe stomach pain, yellowing of the skin or eyes); symptoms of pancreas inflammation (eg, severe stomach pain with or without nausea or vomiting); unexplained weight loss; unusual bleeding or bruising; unusual pain and discoloration of the skin; unusual tiredness or weakness; vaginal discharge; vision loss or other vision changes (eg, blurred vision); vomit that looks like coffee grounds.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.