Do I go on Methotrexate?

Posted Mon 22 Nov 2021 18.03 by steph

Hi all, First post here after lurking! Sorry this might be lengthy. I’ve suffered for about 3 years now, my psoriasis is 90% better than it was at the start but it’s still getting me down. My worst areas are on my scalp and the private region (where it started and was the worst and as a result I haven’t been intimate with anyone since it started) then I have patches on my elbows, one on my back, couple on my legs, a bit my by ear and a couple tiny bits on my face. Basically a patch on every body part… I know I’m ‘lucky’ and there are people who suffer much worse! I’ve been given everything the GP can give and was then referred to the dermatologist at the beginning of the year who gave me Enstillar and a couple other ointments. Whilst they help in certain areas, they don’t really touch others and to be honest, applying all this gunk everyday is getting tiring. They did suggest the phototherapy but with a full time job I can’t see how it’d be possible to go the multiple times a week to a hospital that’s 30+ minutes away. They told me research Methotrexate which I’ve done but is it really as bad as it’s made out to be? I do know someone who’s had their liver affected by it so I know it’s not a myth! Im 31/F and I rarely drink (a few drinks a years maybe), does that make it anymore likely that I may not get off so bad? Are there any other options? What has your experiences been with Methotrexate? Yep, long post. My apologies and thanks in advance!

Posted Mon 22 Nov 2021 18.20 by lizziep

Hi Steph There are lots of options and the uk dermatologists seem to work through them. Methotrexate didn't agree with me, but others report staying on it for years and they monitor you so they won't let anything happen to you. My understanding is that not drinking makes you a better candidate. It is a very depressing disease - everyone here understands.

Posted Mon 22 Nov 2021 20.10 by CBMan

Steph, I was on Methotrexate for about six months a couple of years ago. In my case it was very effective. I've had Psoriasis for more than 30 years and while I was on Methotrexate my skin was as clear as it has been in decades. Unfortunately in my case I also have Psoriatic Arthritis (PsA) and Methotrexate proved to be completely ineffective at treating that. After discussions with my Rheumatologist I decided to come off Methotrexate and go back on Sulfasalazine. Like you (from what I can tell) I found the literature that I read prior to going on Methotrexate fairly alarming, but in my case I didn't experience any side effects whatsoever. The last blood test that I had before going off Methotrexate did suggest the very earliest signs that I might be starting to experience some liver problems. However, as I then stopped taking it I never found out whether there was actually going to be an issue. My experience with various treatments suggests that treatments affect different people differently. My experience probably will not be the same as yours and finding the right one for you will mean being open to trying different options.

Posted Tue 23 Nov 2021 21.43 by Steview
A P sufferer for over 30 years, through good and bad times.

Hi Steph, if you read the fine print of most meds and even everyday meds like paracetamol or asparin there could be lots of scary side effects. If you cannot attend phototherapy, systemic I.e tablets are your next option after all the ointments and creams have failed. I. M. O. It is a balance between the chance of improved quality of life and accept some of the side effects may occur. You will require frequent blood tests on mtx, so if there is problems the docs should pick up on it. As previously mentioned mtx can be a long term treatment, personally I took it for ten years with relatively good clearence. I did suffer the common nausea and drowsyness but I felt that was worth it for a day or so to have a relatively normal life. One point especially for females is if you plan a family then there may be restrictions on the use of mtx just like other meds. Good luck.

Posted Wed 24 Nov 2021 11.22 by rapture83 (edited Wed 24 Nov 2021 11.24 by rapture83)

If you are sightly concerned about MTX you could ask your derm to put you on Otezla pills, these pills do not effect any internal organs so no regular blood tests are needed, it’s a pill in the morning and 1 at night! I’m on this at the moment, I’m about 2-3 weeks in, I think I’m seeing a slight improvement but apparently it can take up to 16 weeks before any results show, in my case I’ve been told that if I see no results in my guttate P with this then the next step would be MTX. A lot of people have side effects with Otezla which are mainly nausea, diarrhoea and sickness but so far with me apart from 1 day I’ve been completely fine! Otezla I don’t think is as strong as MXT which explains the no blood tests but for a lot of people clears them! It’s another option for you to start of with, just thought I’d let you know! Thanks

Posted Sat 11 Dec 2021 21.08 by steph

Thank you so much for your replies. Sorry I was late in getting back! It’s definitely more reassuring hearing from peoples personal experiences. I think I’m going to try and get in contact with the dermatologist again, even if just for another chat as it’s flaring back up quite bad again and now I’m blessed with patches on my nose, yay.. I think my worry is I don’t have it ‘bad enough’ to warrant such a treatment but on the other hand the dermatologist did suggest it and I guess they wouldn’t for no reason 🤷‍♀️

Posted Sun 12 Dec 2021 07.26 by rapture83

No probs! I’m in my 3-4 week period of Otezla, I thought it was clearing but its kinda just back to normal, nothing worse or better, not as bright red as before but still there! I’ve got my catch up with the Dermo next week, recon he’ll keep me on this as it can take up to 16 weeks, I’m having no symptoms taking these tabs also which is a bonus! If I see no improvement by week 16-20 I’ll be going on MXT so keep us posted if you go that route too!

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