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Methotrexate (or some other medication) for RA Fatigue

I am a New RA diagnosis 2020 but struggling with progressive, persistent fatigue x5 years pre diagnosis. Still struggling. On plaquenil now since July 2020. It helps with the joint pain. Not so much with the fatigue. Rheumatologist is recommending Methotrexate as a next step option. My concerns? A lot of information about MTX highlights that it can actually Cause fatigue, and lesser information is out there about it helping the fatigue. My question to the community? Are you taking Methotrexate and has it helped with your fatigue? If you are not taking Methotrexate and something else is helping - another medication - then what is that medication? I am doing all of the behavioral interventions with 8-9 h per night sleep on cpap, resting, prioritizing, weight lost [still overweight BMI though] all that, but really struggling. FYI The AIP diet has done wonders and I am grateful. I just want to be a normal functioning adult

  1. Hi , Fatigue can be truly debilitating. I understand. Let me just share what my experience has been. When I was first diagnosed, my rheumatologist prescribed three medications: methotrexate, sulfasalazine, plaquenil. This approach is called "triple therapy" and is very common. Some rheumatologists might choose to prescribe only one or two at first, as yours did. For me plaquenil caused extreme fatigue that was undeniable. I only lasted on it for one week.

    Methotrexate on the other hand has not caused fatigue for me. Instead as it brought my disease under control, my fatigue was lessened. One tip I have when using methotrexate is to take it just before bedtime. That way any short term side effects such as fatigue pass while I'm asleep.

    All that you've asked here would be excellent topics to discuss with your own rheumatologist. Each of our bodies are different and we may respond to medications differently. I'm glad to hear that the AIP diet has made such a positive difference for you. That's great.

    Best wishes, Lisa (RA Team Member)

    1. My rheumatologists prescribed sulfasalazine and Humira when I go to his office, I do not qualify to get Humira around the clock. I m constantly in pain. My energy level is usually for about 35\40 minutes, then I will have to sit or lay down for awhile. I wear a back brace and knee brace to try to keep some of the pain down. The knee brace helps but I don't see any improvements for my back.

      1. Hi there I'm so sorry you're dealing with this. I know it doesn't change the pain you feel right now, but you aren't alone. I'm sharing a recent thread of a community member experiencing back and knee pain as well - the reply in the thread might be helpful as well. I hope you can feel better soon! - Reggie ( Team Member)

    2. I understand that injectable MTX has less GI side effects. Anyone experiences with other side effects? With Hope and Best Wishes, Jo (moderator)

      1. I take injectable and the GI issues are minimal but the fatigue issues continue - due to the disease (all the time) and the reaction to the MTX worsens it for a day or two.

      2. Hi . My wife, Kelly Mack (a contributor here), also had the additional MTX fatigue (and brain fog) when she was on it. In fact, she would take it on Friday nights so that she could recover over the weekend and not have it impact her at work. Best, Richard ( Team)

    3. I agree. I am now taking injectable mtx and the fatigue isn't so bad. The nausea has subsided for now.

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