WBC, CRP, and Sed rate starting to climb after a few months on MTX

[SpaceflightAddict]

Well, I knew this was coming. I have been feeling pretty crummy for the past month and a half, and my last bloodwork pretty much confirmed what I had been feeling. WBC went from 7.1 to 13.1, CRP went from 2.4 mg/L to 9.1 mg/L, and sed rate from 4 mm/hr to 11 mm/hr.

What a bummer.

The recent problems started about a month and a half ago, when I tapered my prednisone from 5mg to 4mg. I usually feel pretty bad for a couple of days after a pred taper, but this time it dragged on a little too long. A little bloody discharge from my nose prompted me to call my rhumey and primary doctors, and they wanted to make sure it was not just a sinus infection first. After a week and a half on antibiotics, with not much improvement, my rhumey upped my MTX to 25mg, and i've been there for a little over a month now.

Where to go from here? I suspect that more prednisone will be the short term answer (ugh). In the longer term, i'm not sure. I am already at the highest dose for MTX, so maybe some other drug is in order. I really doubt they will put me on CTX again. My insurance does not cover Rituximab, but if that is an option, I will try to get the co-pay card from the manufacturer. Appointment with the rhumey is scheduled for this Monday, so I guess I will find out more then.
It's been just over a year now since I first became sick, and 10 months since I was diagnosed, and I am a lot better than I was this time a year ago, but this disease is just getting annoying now

Just wanted to rant a little bit. Thanks for listening yall.

[annekat]

Sorry to hear this, Andy. (Hope I'm not goofing up on names again.) It sounds like what I've been through with some minor flares. The first time, I think it was the low dose of MTX, so that was bumped up from 10mg. to 15mg. As an afterthought, my pred also was bumped up from 10mg. to 15mg. That worked great, between the two things, and I'm still on the 15mg. MTX. The second time, this winter or early spring, I'd gone down to 7.5mg. pred when I started feeling crappy and the tests confirmed a flare. The MTX was left alone and the pred was put up to 20mg. because I was having some weird symptoms like vertigo. This worked but not as fast, but I'm better now and down to 15mg. pred again. In your case, since you can't take more MTX, just increasing the pred a bit might make a difference and you'll feel better. To me, at the level of pred you are at, that would be preferable than going through the whole thing with getting RTX. I can't say how much to increase the pred but it might not have to be a lot. 7-10mg, maybe, for starters? But this is all conjecture, as our cases are different and I don't really know how bad you feel or what your symptoms are besides the bloody discharge.
Your number increases don't sound all that extreme, yet, but then I don't know a lot about those numbers. I know my sed rate was up to like 67 this winter and never really gets below about 20. I think it is different for women than for men; from what I've read, women are allowed to have a little more inflammation. We are all a little different. So anyway, I'm rambling, but I'm glad you took the time to rant and complain as we all need to do that sometimes. Someone will have more thoughts on this, no doubt. Best of luck with this.

[Alysia]

I am sorry Andy it might be a reaction to the reduction of pred, or a flare or smoldering.... God knows.
I wonder if few days of more pred can "fix" it...
I think you should ask your wg-doc about it.
I understand your sorrow and fears and frustration. I am sending prayers and hugs to you
please update us.

[Dirty Don]

Give the mtx a couple more weeks as any change is like starting over again and the body needs to adjust to it. Pred change to more is definitely necessary for a while it seems. Rtx will change things for you if you have to go there. On the other hand, I felt much like you do at about that time in the dx/treatment (same drugs/doses). Just couldn't find enough spoons nor days to feel better...somewhere at around 2 years I felt definite changes...now, at 3 years am feeling as well as I have in quite a long time. Be patient and have fortitude...they work the best. Best to you.

[Alysia]

Don, I couldn't move on without realting to your new avatar and your new signature: timid or bold, no matter, your full value is acknowledged here, no compromises needed no strikes either