How long does it take Methotrexate to start to work?

[Jennie]

Hi Everyone

I am just back from another disappointing appointment with my ENT. He used the camera again to check on my throat (supraepiglottis and vocal chord region) and there has been no change since my last visit a couple of months ago. I have been taking 15mg of methotrexate weekly since the beginning of January so I had been hoping that it would have started to work on shrinking the epiglottal granulomatosis by now.

I have been told by my Rheumatologist that Methotrexate takes a while to work, but 3+ months? Am i just being impatient? I was on Prednisone also from the beginning of January for about 6 weeks. The Rheumatologist said it wasn't helping so he took me off that.

Any thoughts or comments would be greatly appreciated.

Jennie

[delorisdoe]

Prednisone alone does not treat wg but it is usually used with the other drug of choice. I have never heard of a doctor taking you off of prednisone "because it is not working". It sounds like maybe your Rheumy is confused.

[pberggren1]

Jennie, you need a Wegs specialist. Obviously your current Rheumy does know Wegs. If I were you I would contact Marta. She has a good doc in ED and knows of others as well.

[mishb]

Hi Jennie,

I was told 6 to 8 weeks for MTX to work fully.
Maybe your dose needs increasing.
I was on 10mg for about 6 months, with little to no improvement, then went to 15mg, a little improvement and now have been increased to 20mg and blood results are showing good improvement.
As MTX is more a maintenance drug, maybe it takes a little longer for results.

[Sangye]

I agree that you need a Wegs specialist. (Okay, okay, I think everyone does, but still.) The mtx wasn't really working fully the entire time you were on pred, so it isn't surprising to me that mtx alone is not resolving the granulomas. Basically he's using pred OR mtx to treat it, and that won't work.

[Dirty Don]

Jennie, my mtx dosage took almost 6 mos for me to start feeling substantially better. Maybe that's an anomaly, but I was told it would take longer than some of the other more toxic meds. But, was never off pred until the mtx kicked in, in the docs' opinions. Am now tapering the pred, but slowly. Good luck.

[dutch]

My son's doc upped the dosage over a course of 8 weeks from 15 to get to 25 mg, along with pred. (increasing MTX while decreasing pred was the goal) His symptoms always seems to be just under the surface-some ear pressure, throat pain, shortness of breath,etc., especially as he started to decrease the amount of prednisone. We were told by a Wegs specialist that at the first sign that MTX is not working enough, you have to switch to get the inflammation under control. The first time getting it under control is often the most difficult. He eventually went to RTX. Try to get some input from a Wegs specialist. Good Luck!!

[me2]

Here is my understanding, someone correct me if I'm wrong. Prednisone use is better than the disease, MTX use is better than prednisone. But to take you off prednisone without having something else that is working is basically not treating the disease at all. As evil as prednisone is it is an important tool to buy time to find something else to do the heavy lifting.
Prednisone use is better than the damage the disease can cause - certainly for the short term.
It doesn't seem right to take you off the prednisone without seeing some positive results first.

[Jennie]

Thanks everyone for all your input. It certainly gave me a lot to think about and helped me come up with questions for my Rheumatologist at my appointment yesterday. We agreed that the Methotrexate wasn't working and we discussed other options at length. The Rheumatologist actually paged my ENT while I was there and they came up with the next step. So as of today, I am taking Imuran starting at 50mg daily and increasing over the next couple of weeks to 150mg. We will give that a while to hopefully work and if not, the next step may be RTX. I also went for bloodwork to check ANCA yesteday. No word yet on the result but it hasn't been checked for a couple of years.

Anyway, I feel more hopeful today knowing that we are trying something new.

Have a great weekend,

Jennie

[drz]

Thanks everyone for all your input. It certainly gave me a lot to think about and helped me come up with questions for my Rheumatologist at my appointment yesterday. We agreed that the Methotrexate wasn't working and we discussed other options at length. The Rheumatologist actually paged my ENT while I was there and they came up with the next step. So as of today, I am taking Imuran starting at 50mg daily and increasing over the next couple of weeks to 150mg. We will give that a while to hopefully work and if not, the next step may be RTX. I also went for bloodwork to check ANCA yesteday. No word yet on the result but it hasn't been checked for a couple of years.

Anyway, I feel more hopeful today knowing that we are trying something new.

Have a great weekend,

Jennie

Hope the Imuran or its generic azathioprine works for you. I have been on it for 15 months and my ANCA scores has decreased and inflammation markers kept low most of the the time. No real problems from it except liver enzymes increased so I had to cut back dosage and decrease statin BP meds too. I started slow too and worked up to 150 with bump to 200 during flare which it handled OK. Now at 175 for past year. Good luck and best wishes for better health.