Rheumatoid Arthritis Support Group
Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...
I was dx April 13, 2011 with RA. My only pain was in my hands and shoulders. Once I started MTX (4 pills a week) I experienced a new joint pain every week. I've since landed in the hospital for a blood transfusion due to low blood and severe anemia. I've also lost over 60lbs since I started this med. I'm starting to worry because I lost an additional 15lbs since August and my GP informed me that my liver panels have not been checked after all of this time. She also indicated that my kidneys were showed a bit of protien. I started Humira about a month ago and seems to work better than the MTX. My mom wants me to stop the MTX to see if I get better. She seems to think I've gotten worse since starting it and she may be right.
Has anyone else experienced the extreme weight loss and anemia from MTX? Should I stop taking it without weaning? I've bought this to the atttention of my rheumy and his only response was "this is what we prescribe for RA." Again he's creeping me out because I should be seeing some improvement since I started it in April. I can barely walk now due to my ankles and knees.
Has anyone else experienced the extreme weight loss and anemia from MTX? Should I stop taking it without weaning? I've bought this to the atttention of my rheumy and his only response was "this is what we prescribe for RA." Again he's creeping me out because I should be seeing some improvement since I started it in April. I can barely walk now due to my ankles and knees.
The reason you should have the kidney and liver function monitored closely is that MTX is toxic. If it works, well, that's why we all take the risk to take toxic drugs in hopes of going into remission.
I would ask your PCP to run both kidney and liver panels, and if your rheumy doesn't take you off the MTX, your PCP should.
If its been since April that you started the MTX, that's almost 6 months. That is certainly long enough to see a response. If you have not had an improvement, its time to start a new medication. I know that its preferred to use MTX along with the biologics, but again, its been six months. And you've already started the Humira, so you won't be without treatment if you stop the MTX.
I say stop the MTX, do it with your PCP's help if your rheumy won't do it. Its your body, and you know how you feel. I don't know what your beginning weight was, but it sounds as if you've lost a little too much weight. I hope you start feeling better.
Chronic inflammation changes your metabolism rate so that is a reason why weight loss is a symptom that accomanies RA. RA is a progressive disease and the rate that the progression takes place varies from person to person. Who is to say that you wouldn't have had the same progression without the mthx. That being said, some people do not tolerate the mthx as well as others. Do you see a primary doctor? My PCP was very worried when my RA meds were not working at all and I was losing weight every week. I was also dealing with a serious anemia problem at the same time, another rA symptom and so I think all of this goes hand in hand. It is a difficult balancing act to fix the layers of problems that RA creates and my PCP told me that having to take the serious RA meds is on the same level as having cancer and needing cancer drugs. This is stuff to take seriously and if you are having concerns that are not being met then try to get a second opinion. This does not lock you into switching doctors, but maybe even if the end result is the same you might feel better if you find a doctor who you feel is listening to your concerns and addressing them. As for the bloodwork, I agree with Madi and that should not be left unchecked. As for the progression issue again, there are a couple of different ways this disease can manifest itself and while some people have a sudden onset that is crippling, most people develop the problems in the joints one by one until all that is going to be affected is affected.
If it were me, I would change my Rheumy but, please, at least, get a second opinion.
I have been dx for close to 2 years now. I started MTX in April, 2010 and have blood tests to monitor liver function, and a range of other factors once a month so five months without a blood test is, in my opinion, negligent. I have experienced low WBC count and borderline anaemia from MTX and see a haemotologist to monitor that (referred by my Rheumy). Unfortunately, weight hasn't fallen off me like you but I do understand how worrying that is. 10mg of MTX is a fairly low amount. I take 25mg a week and it was 11 months before it really kicked in-I am resistant to medication, I know, from previous problems with no connection to RA.
Until your Rheumy problem is resolved, I would be guided by your PCP who seems to be very much on-the ball.
Cheers
I have to agree with offtrack here. You cannot say for sure that the MTX has caused the weight loss and anemia. Many with RA will have anemia, and also you can get weight loss. Both of those indicate that your RA is not under control (obviously, with all your other symptoms too!). RA can progress rapidly despite treatment. I am glad your doc started Humira, because studies show that combination treatment is more effective than a single DMARD alone, and studies show that MTX boost the effects of the biologics like Humira as well. And 10 mg of MTX is a low dose.
That said, IMHO, prescribing MTX without doing monthly labs is irresponsible on the doctors part. I have been to several rheumys in the past yr (dx'ed 10/2010), and at a MINIMUM I had a CBC and liver panel monthly. Many rheumys do a complete metabolic panel monthly also - which includes other electrolytes and kidney function too.
I certainly feel that you need the bloodtests from whomever will order them for you - whether it be the RD or your GP. That said, I'd also consider changing RDs or at least going for another opinion considering your lack of improvement as well as lack of monitoring.
Keep us posted - hope you're feeling better soon!
good Luck