symptoms back after six months on MTX

[makabe]

I see one of my rheumatologists next week (will see Dr. Merkel at UPenn April 3) but am curious about a new flurry of symptoms I am having. I've been on MTX and prednisone (tapered down to just 5mg right now) since July. I got sick Dec. 30 and since then have had two major sinus infections, an ear infection, the flu, and bronchitis, plus two really odd bloody noses. Both woke me up in the middle of the night. I've never had that before. About a week ago, my left hip started to hurt. Both are hurting today. My left knee has hurt about every other day and my back has hurt intermittently for a couple of months, too.

This all seems odd to me when I was doing so well on the MTX until now. (I take 25 mg a week.)

Any advice? I had blood tests today. The last round showed elevated CRP and ANA for the first time in a very long time, but I was getting sick.

Thanks!

[Pete]

Sounds like you've been flaring for a couple of months. Please call your doc and get some guidance (at least) or an earlier appointment.

[Dirty Don]

I was told at some point my mtx dosage may cease working well enough, then I would be on to rtx. You are definitely flaring...it may be that the mtx isn't/can't do what it was for you. Perhaps an increase in pred could help...but make sure.

[drz]

I see one of my rheumatologists next week (will see Dr. Merkel at UPenn April 3) but am curious about a new flurry of symptoms I am having. I've been on MTX and prednisone (tapered down to just 5mg right now) since July. I got sick Dec. 30 and since then have had two major sinus infections, an ear infection, the flu, and bronchitis, plus two really odd bloody noses. Both woke me up in the middle of the night. I've never had that before. About a week ago, my left hip started to hurt. Both are hurting today. My left knee has hurt about every other day and my back has hurt intermittently for a couple of months, too.

This all seems odd to me when I was doing so well on the MTX until now. (I take 25 mg a week.)

Any advice? I had blood tests today. The last round showed elevated CRP and ANA for the first time in a very long time, but I was getting sick.

Thanks!

This sounds very familiar to me. I had a bad sinus infection, then bronchitis, and finally a regular cold this winter. My residual Wegs symptom flare up then, pain in joints, bloody sinus rinses, and increase in inflammation markers. In the past I had both ear drums rupture from infections. Our maintenance meds can't always prevent any flares but should help reduce the intensity of them so the flares won't be as serious or life threatening as our condition during initial diagnosis. Some times you can get back in drug induced remission with little change in meds and other times you need a more powerful drug to get it back under control. This is where you need the advice or help from an expert.

[Jaha]

I think that everyone is right you are in a flare. Can you talk with you dr over the phone or by email and let them know about all that is happening to you? MTX did not work for me within 3months of use and then I was put on Imuran. Best wishes to you for a solution to getting better.

[Psyborg]

Gonna agree...that really sounds like a pretty substantial flare. It may take RTX or CTX to get things back under control.

[makabe]

Thanks, everyone (And sorry, Bob! I think I accidentally replied just to you...)

I had a suspicion this is a flare, but having only been on meds for WG for a few months, I wasn't sure what to expect. I started on the MTX/pred. I've never been on CTX or anything. Is there an obvious next step to try? It seems like I hear most about CTX, but are others an option? It seems to me like MTX isn't doing enough to stop the symptoms.

[Alysia]

Hi Karen,
I have similar story: MTX for couple of months. a little bit better but lately my joints are red and aching, I cough a lot, my ears aching and my nose is in terrible state. my WG doc decided to move to rtx. I was on 5 mg pred but now he told me to take 30 mg pred for a week, then 20 for a week, then 10 for a week and then back to 5 mg.
It is important to stop the flare as soon as possible.
good luck.

[drz]

Gonna agree...that really sounds like a pretty substantial flare. It may take RTX or CTX to get things back under control.

Only other alternative that might be worth trying is to increase dosage of current drug if you aren't maxed out on it along with increase in pred too. Again this is where you need expert advice from some one familiar with you and your history and expertise in treating GPA.

[annekat]

Karen, the same thing happened to me after a few months on MTX, I went into a flare, though it was probably helped along by getting a cold and by stress. HOWEVER, I was only on 10mg of MTX, having switched from CTX after being brought pretty close to remission, seemigly. So my suspicion is that the 10mg wasn't quite enough in the first place to maintain me at that improved level. My doc has upped it to 15mg., which has pretty well brought the flare under control. I see you are at 25mg., a lot more, so it is a little different; I don't know how much they would want to increase it or if would move to a different med. Since you haven't taken CTX yet, that could be an option, though many on here would say RTX would be the preferred choice. I did well on CTX, even at a slightly lower dose than recommended for my body weight. But I was on it for quite awhile and doubt that anyone would want me to resume it.