New diagnosis. My biggest issue is fatigue and brain fog, though I do have some joint pain in hands mostly but it is minimal. Doctor prescribed Methodrexate but im very concerned about it causing more fatigue. Help?
I struggle so much with fatigue and brain fog that it has already affected my ability to do my work etc. I don't know if I can justify taking methodrexate if it causes more problems for me this way. I tried to talk to my doctor but she didn't seem super receptive to my concerns.
She diagnosed me with RA and unspecified MCT disease. My main symptoms are extreme fatigue, brain fog, peripheral neuropathy, occipital neuralgia. I do have joint pain in hands somewhat and a bakers cyst that has gone down quite a bit and some hip discomfort occasionally. But I can deal with those. I cant deal with the fatigue. I am very very anxious about taking methodrexate for this reason. She did prescribe a methylfolated folic acid as well but as far as I understand this is to help with nausea mostly? Idk what to do. I also feel like, while I definately have some markers: positive RF igm and T igm as well as dopler signals on ultra sound, I don't have a lot of tge other high indicators. Just looking for guidance and help. Thanks much.
I began that methodrexate pill 3 pills to 5 pills for a year I had lumps on my wrist bones,was not improving doctor wanted to start infusions,I did not want that.
now I am on Leflunomide 1 pill a day since May 2025, nodules on wrists and knuckles have come down,yet what about pain management?
I am so happy to hear you have found that Leflunomide helps. I am not in a great deal of pain, joint wise, so that is why this decision seems more difficult. One of my main issues is fatigue, headache and brain fog. I know many people experience this as a side affect, which is what is causing my pause over it. Thanks for asking.
Hi
. Your concerns about fatigue and brain fog are understandable and many here are right there with you. One of the things that make these symptoms so difficult is that, while methotrexate can have these as a side effect, the disease itself can have these symptoms. In fact, I want to share with you this article from Daniel on fatigue: https://rheumatoidarthritis.net/living/morning-fatigue. If you read the excellent comments section you will find information into research into the root causes of fatigue and brain fog, such as how autoimmune inflammatory cytokines can impact energy at the cellular level or how they break through the blood-brain barrier. Both of these things can increase fatigue and brain fog.
That said, methotrexate can absolutely exacerbate these issues. My wife, Kelly Mack (a contributor here), used to take methotrexate early Friday evenings, so that the "methotrexate hangover" wouldn't interfere with her work week. I can tell you that folic acid helps with more side effects than just nausea, including such things as liver function, hair loss, and fatigue, so it is very important that it is taken as part of the methotrexate treatment regimen. Folic acid, however, does not tend to eliminate the side effects. It is also possible that you are having particularly bad reactions to the medication. In addition, some do find that side effects are particularly bad at the beginning, but level off after some time (I by no means want to downplay what you are experiencing, just noting this can happen - trust what you are feeling). If you are finding that the impacts of the methotrexate are worse than the level of disease activity you were having, don't hesitate to speak to your rheumatologist about this. It is always your choice on what treatment you take. There are now a lot of medications for RA (see: https://rheumatoidarthritis.net/treatment/drugs-and-prescription-medications-for-ra) and your doctor should be willing to work with you to find a treatment that is right for you. Hoping you get some answers soon and please feel free to keep us posted on how you are doing and to ask additional questions. Best, Richard (Team Member)
Richard,
Thank you, so much, for your thoughts and information. I have been reading through the links that you sent. All of this is helpful. I haven't as yet started on MTX, but I do struggle, quite a lot, already with brain fog and fatigue. That is why I have been worried about having more of this caused by the drug. But I have decided to go ahead and try it. Also, I am aware that my insurance requires me to try this before I can move on to other medications. I am glad my doctor prescribed the folate to take along with it.
I appreciate everyone here so much and I am planning on reading more of the discussions and topics.If you take the Folic Acid everyday except the day that you take your Mtx this really mitigates the side effects. I used to take my Mtx on a Friday night to allow 48 hours to get over the worst of the nausea and fatigue before work again on Monday. I certainly couldn’t have worked on the Saturday and just stayed in bed and rested up.
I went over to injections of Mtx for fewer side effects. But you need to stick with it religiously for 3 months before you know if it will work for you. It’s the Gold Standard first drug for RA and if there is no improvement in 3+ months you can be offered something else.
Untreated RA is no joke and in the past delays in diagnosis have meant increased joint destruction and disability so it’s important to keep on with the treatment even though it may feel worse than the disease at present. RA is a progressive disease without a cure but with the newer drugs now available it can be managed well.
It’s important to educate yourself - lots of info on medical sites online and this website is a fabulous resource too. Have a read through the library of topics available. You’re not alone, we all understand what the early days are like so do post any questions that you have on here and you will get a reply from the moderators and other members and be signposted to information that will be helpful😀
Go well,
Cece.
