Pain solutions while beginning methotrexate
I am starting on methotrexate, so far I've only had one week's dose (oral). The first time I tried this I couldn't stand the pain without ibuprofen or naproxen, so I quit. I am back in the same position again, the pain is agonizing. Without being able to use nsaids, what would you recommend I try to get my pain under control?
Thank you.
Hello
. I'm sorry to hear that you're dealing with pain while starting the methotrexate. I can hear how much pain that you're in. If you haven't already, I would definitely reach out to your doctor about what your options are if you are unable to take ibuprofen or naproxen. Your doctor should be able to help support you in between starting the methotrexate until you start to feel some relief.
I do also want to share this article from one of our advocates about some of the pain relief therapies she finds particularly helpful, https://rheumatoidarthritis.net/living/pain-relief-therapies. And hopefully some of our community members who have similar experience can share what they've found helpful with you as well.
I'm sorry I couldn't be more specifically helpful, but please know that our community is here for you. I know it has been a couple days since you first posted. How are you managing today? Sending you gentle hugs. -- Warmly, Christine (Team Member)Hi there! My rheumatologist is calling in some prednisone for me, so hopefully over the next few days I can get this flare up under control. Thank you again, I'll keep you posted! oh that's great! I hope you can get the flare under control quickly! -- Warmly, Christine (Team Member)
Hi
. On top of the excellent in information I want to note that with methotrexate "It can take three to six weeks for your symptoms to begin to improve. It may take up to 12 weeks before you notice complete benefits:" https://my.clevelandclinic.org/health/drugs/20143-methotrexate. I mention this so that you know in any discussions with your doctor how long you may need something to help with the pain. In the article Christine shared the steroids are the one item that it sounds like you can take that will treat the inflammation and, thus, RA symptoms. It often considered a short-term treatment, but one of the potential solutions you could discuss with your doctor. Hope you get some relief and that you are on the shorter end of the time for the methotrexate to kick in. Please feel free to keep us posted on how you are doing. Best, Richard (Team Member) Richard, I appreciate your reply more than I could tell you. Thank you for bringing that to my attention! The longest I'd seen was 6 weeks but it makes sense that with some it might take longer. It's my cmc joints that absolutely kill me, my left hand has hurt for two years. I keep a brace on it part of the time per the rheumatologist but it isn't getting any better. She said it's osteo though, not RA. I home the methotrexate still has some affect, regardless. If not, I'd like to speak with someone about removing the one hand... 😉
Thank you again for your kindness!Hi
. Thank you for the kind words - you made my day. It is true that CMC joint issues are often osteoarthritis, but, as discussed in this article from the Arthritis Foundation, they can also come from RA and other forms of inflammatory arthritis: https://www.arthritis.org/health-wellness/treatment/joint-surgery/preplanning/five-surgeries-for-thumb-arthritis. I tend to think of it as hand in hand - given time everyone with RA will have OA and RA can impact any joint. That article is discussing surgeries, but, hopefully, there are other options such as a cortisone shots. I can also tell you that my wife, Kelly Mack (a contributor here, who was diagnosed at age two, 45 years ago), has wrist braces that were specially made (formed) by a physical therapist. I don't know if something like this would help, but it might be worth asking about.
I hope the methotrexate kicks in (beats the alternative you mentioned 😀 ). I saw in response to Christine that you have a pain specialist (with the connection to the rheumatologist), so hope they can help. Best, Richard (Team Member)
Hi again! My rheumatologist is calling in some prednisone for me, so hopefully that will help over the next few days. I have tried two steroid shots in my hand so far, but neither of them did a thing, unfortunately. Also, the hand surgeon that I initially went to for my CMC joint pain sent me to a physical therapist to get a brace made, and I wore those for about a year...but then when I went to my rheumatologist, she told me she wanted me wearing a spica splint about half the time, and said not to use the custom one from the hospital at all.
I tend to think she's right, but I have to admit, my pain hasn't changed since I began using the spica splint as she instructed.
As far as OA vs RA, I think you're probably right on the money. The way they talked, I guess they can tell by looking at the xray which type of arthritis it is. I assumed that was the case, but I can't back that up 😉
Thank you again!Hi
. Hope the prednisone helps. You should be able to feel a difference pretty quickly. I'm a little surprised the shots didn't do anything, but not unheard of. I personally had one in my hip for bursitis that did nothing. You are correct that there is a difference in the x-ray between OA and RA. In the case of AO the gap between the bones increases due to loss of cartilage, whereas RA often shows more erosion on the bone (see here for example: https://www.healthcentral.com/slideshow/osteoarthritis-and-rheumatoid-arthritis-differences). Please feel free to keep us posted. Best, Richard (Team Member)
I have been on 10mg prednisone for a few weeks, now which does not do very much for me. I've been researching Methotrexate drug interactions and have requested from my doctor to stop the prednisone and continue the ibuprofen. I was just prescribed methotrexate (have not started yet) but was doing some drug interaction research, and realized that I should not have been taking ibuprofen along with the prednisone. so I stopped the ibuprofen and continued the prednisone. The prednisone itself did not provide much relief for my symptoms at the current 10mg dosage, the ibuprofen seems to provide much better relief. I did more research and do note that there is a possible issue related to bone marrow toxicity when mixing the two as well with methotrexate alone at high dosage. Most of the research points to high dosages on methotrexate 25 mg or more with NSAID. Since most RA patients are low dose methotrexate 7.5 - 15mg. I do not see that the bone marrow toxicity would be an issue. My proposal was to stop the prednisone and take 600mg ibuprofen 4x day for a total of 2400mg/day and up dosage to max 3200mg/day if necessary. this issue can be revisited if I require >25mg/wk methotrexate.
references:
https://www.drugs.com/dosage/ibuprofen.html
https://www.welltheory.com/resources/what-is-considered-a-high-dose-of-methotrexate-for-ra
https://www.drugs.com/drug-interactions/ibuprofen-with-methotrexate-1310-0-1590-0.html
https://pmc.ncbi.nlm.nih.gov/articles/PMC3667469/
https://www.verywellhealth.com/methotrexate-interactions-5112866
https://www.goodrx.com/ibuprofen/interactionsHi
, it sounds like you've done a lot of research and I applaud you for advocating for what you feel comfortable with. Have you had a chance to speak with your doctor about the changes you'd like to make? -- Warmly, Christine (Team Member)
