Hello from Europe 2 :)

[Wegetarian]

For some strange reason the forum is acting up on me. The first thread I made here could only be seen by me. The second thread worked for a while, but now it opens up empty for me. If I log out or use a browser where I'm not logged in I can see it just fine but of course I can't reply in the thread since I'm not logged in

So I'll create a third thread... Mainly since there were some discussion in a few other threads and I didn't want to hijack them since it wasn't relevant to those threads. And also because I liked having my own thread

I see no reason (but I haven't read everything you've posted) why the docs are building mtx up in you...it is imperative (in my and Mayo's collective mind) that you and the docs are aggressive with this disease as it doesn't let up if you don't keep 'feeding it' drugs. A build up is simply causing you problems that you don't need to face...they need to get to the dose they want you on to keep the WG off your back...or maybe they don't know or believe that protocol works...hmmmm...best of luck.

Don't know really. I mean I got curious about what you posted. From what I discussed with the doc it was to keep the side effects to a minimum while upping the dose. Wasn't too worried about that, it felt a lot more silly when they sent me home from the hospital and I heard that the treatments should start immediately but they said it will take a few weeks before I get a note from the rheymu clinic for a doctors appointment. I mean what sense is it to wait for weeks just popping cortison since taking MTX or cyclos doesn't seem like such rocket science after I've been diagnosed... They did take me back though once it was clear I wasn't getting any quick appointment to the rheumy clinic.

My guess is that they follow the EULAR guidelines. Not really sure though, all I know is my doc has consulted specialists so I do trust they know what they are doing. I did some googling after your post and some studies do recommend starting from lower doses and going up from there. Haven't seen values as low as 5mg though (which I started with). But it might be due to the pill size too, I mean I have 10mg pills which I could easily put in half.

Here are some quotes from fairly interesting articles I found on the subject:

http://www.medscape.org/viewarticle/712891_5

For years, MTX use has been suggested as, and tested in several open-label studies,^[56-62] a potential induction agent, combined with CS, for WG patients with limited, localized and nonlife-threatening forms. MTX was usually given orally but its weekly dose varied greatly between studies, with starting doses ranging from 7.5 mg/week

EULAR recommendations for the management of primary small and medium vessel vasculitis -- Mukhtyar et al. 68 (3): 310 -- Annals of the Rheumatic Diseases

Methotrexate (20–25 mg/week, oral or parenteral) can be used as an alternative to cyclophosphamide in patients with less severe disease and in whom renal function is normal.13333653^–58 It should be commenced at a dose of 15 mg/week and escalated to 20–25 mg/week over the next 1–2 months, if tolerated. In a randomised controlled trial, it has been shown to be equal to cyclophosphamide in its capacity to induce remission

Initial immunosuppressive therapy in granulomatosis with polyangiitis (Wegener's) and microscopic polyangiitis

A suggested regimen is oral methotrexate at an initial dose of 0.3 mg/kg (but not exceeding 15 mg) once per week, with increases of 2.5 mg each week to a maximum dose of 25 mg once per week. Since methotrexate is a structural analogue of folic acid that can competitively inhibit the binding of dihydrofolic acid (FH2) to the enzyme dihydrofolate reductase (DHFR), folic acid (1 to 2 mg/day) or folinic acid (2.5 to 5 mg per week, 24 hours after methotrexate) should be given concurrently to reduce potential toxicity.

So I guess in summary it seems my starting dose was really small, but its upped with 5mg/week so I'll reach the full 25mg dose in 5 weeks. Next week I'll be taking 15mg assuming my bloodwork is fine and I don't have any more adverse side effects. As I mentioned in the other thread I almost fainted on the way from my bathroom to my bed, and the nurse told me it could be a side effect of MTX My condition was really light from the beginning with Weg to my knowledge only affecting my nose, and I generally feel great besides the fatigue and the nasty feeling I sometimes get in my lungs.