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...

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MTX Dosing

Lori57703
Lori57703
I started on MTX on 30 OCT 2013 after being diagnosed with sero-positive RA. I also take folic acid, Aleve, and Tramadol (if needed). I had my first labs on 26 NOV 2013 and my rheumy had me increase my MTX. I went from 10 mg injection weekly, to 12.5 mg for 2 weeks and then 15 mg for 2 weeks. I have more labs and an appointment with the rheumy the first week of JAN 2014. The MTX finally seems to be helping with the most recent increase. Side effects are mostly extreme fatigue for 36-48 hours after injection and some hair loss.

So my question is, should I expect an increase in JAN? I know some medications are dosed just until an effective dose is found. Others are dosed at a specific level that is determined to be the minimum for effectiveness. I see some people on here are at 15-20 mg and many are at the max of 25 mg so I wonder. I am not on a biologic since my diagnosis is so recent. Thank you. ~ Lori
stephgas
stephgas
from what i've found researching, 25mg is the max mtx dose for RA. i started on 15mg and went to 20mg after 6 weeks with no improvement. after not taking my mtx for a week, i now know that it *was* helping - just not a lot. i should be starting a biologic next week. i was dx'd in mid-september.

as long as you're tolerating it, it's helping, and your bloodwork looks good, i wouldn't think they would lower your dosage. many of the biologics work best when taken with mtx. if the dose you're on is helping but you're not seeing the kind of improvement you and your rheumy want, s/he may up your dosage. my rheumy said she wanted to go right to a biologic because even on 15mg of mtx, my swelling was increasing. i also have a strong family history (aunt, uncle, cousin all on my mom's side have RA).
WaterLily14
WaterLily14
It will probably depend on how your labs look when you go for your next appt,, your symptom relief, and also on your rheumy's personal philosophy on treatment. What I have read and observed though is that the lowest effective dose is usually the goal.

Good to hear that you're seeing improvement!
cindyleb
cindyleb
I am on 20mg pill form though.
I did increase as you did starting out with 10 and within about 6 weeks made it up to the 20.
I have been on mtx, it will be 2 years in April. Have never gone off it, but I rarely get sick so have not had any need to. Got the flu once last year and by the time it was Friday, mtx night... I was feeling so much better I went ahead and took it.
Glad to hear it is working for you!

Cindy
deleted_user
deleted_user
I just started it at 10 mg. So far all I feel is exhausted and a bit sick. Hopefully it will get better and I will feel better...
achymom
achymom
I started at 20mg every week along with plaquenil. I had a lot of relief at that level, but we added Enbrel as there was still some underlying swelling in my wrist (only visible on an MRI). That went away after a few mths on Enbrel. We are now scaling down my drugs - first dropped plaquenil dose first, a few mths later dropped MTX dose to 15, and I am now at 10 weekly. The first MTX decrease was after 12 mths. So far so good. My rheumy wants me on the minimal amt of drugs needed to control the RA. We dropped Enbrel to every other week at my appt in Nov.

Hope you get relief. They have all helped me - but I'm struggling with getting sick with colds all the time (I just posted on that today), so am hoping to get that sorted.