It’s official; I am now a meth head!

Before you start calling my parents or detox centers, let me explain. Last Wednesday I had a check up with my rheumatologist. After explaining how I’ve been doing since my last visit with him, my doctor and I concluded that Plaquenil was not working and it was time to make a change. Since I was getting good and immediate relief with prednisone, we both agreed that my diagnosis was still correct. Plaquenil was just not the right medication for me at this time.

I had started Plaquenil in September of last year because of pain and inflammation in my hands, fingers, and wrists. The pain and inflammation had first appeared in 2010 while working as a temp at the Idaho State Tax Commission. At its worse, I’ve had trouble with things like tying my shoelaces, writing, typing (a highly valuable skill as a tax accountant), holding the handlebars on my bike, dropping items, removing staples, and eating among others. As you all know, our hands and fingers are incredibly important in order to function in life. Prednisone had helped with these symptoms as long as I was on it. Remaining on prednisone for the rest of my life certainly was not an option however; I would not be able to afford to feed the pred monster for one.

At my previous appointment, my rheumatologist and I had started to talk some about what would happen if the Plaquenil did not work. After having had 7 surgeries since 2003 and being an engaged epatient, I’ve learned to ask, “what’s next?” if the current course of treatment does not work. I want to know all my possible options even if I don’t need to exercise them. Much like skiing, I always want to be looking 2 to 3 turns (medical options) ahead. For me, knowing that I have options motivates me to work harder today and takes away some of the sting if a change needs to be made in the future. In my opinion, knowledge breed’s comfort. I’m never afraid to ask questions of my doctor, pharmacist, physician assistant, or other patients and you should not be afraid either.

Thanks to my patient centered rheumatologist, I already knew that methotrexate (MTX) was a possibility if I was not able to get relief with Plaquenil. Turns out that sulfasalazine, and one other med (I’m blanking on the name right now) were a possibility too I learned on Wednesday. Through my own research and conversations with fellow patients and friends, I felt comfortable with my knowledge base about methotrexate. Despite its bad reputation, my acquired knowledge of the med had took away most of the drama usually associated with MTX. I had not heard of sulfasalazine and the med that I’m blanking on in my own research though.



Since no medication is going in my body without extensive questions on my part, I asked my rheumatologist to explain the pros and cons of each of my options. The med that I’m blanking on had a side effect of making me more sensitive to sunburns. As someone who is trying to get back into skiing, road biking, running, and likes doing yard work, I do not want to take a med that might make me more susceptible to sunburns. Sulfasalazine had similar side effects as MTX but was more used for spinal pain and inflammation. This had a lot of appeal to me considering my history of lower back pain. If this appointment had been before my “so far so good” radio frequency nerve ablation I would have chosen it. Sitting in front of a computer for 8 hours a day with lower back pain and swelling is not fun I’ve discovered. Since my pain has been significantly reduced by the nerve ablation however, I was not completely sold on this option.


The final selling point for me was that methotrexate had a better history of being successful with hand, finger, and wrist pain and swelling. Once my doctor mentioned that I was sold! MTX was going to be my next option despite its reputation among the arthritis community.

Since methotrexate can take up to 6 weeks to work, according to my doctor, he recommended that I either go back on prednisone or try a steroid shot in my butt as a bridge. Despite being under the care of one rheumatologist or another since 2003, I did not know that getting a shot in my rear was even an option. Not only is it an option, the evil pred monster is not present in shot form. That meant I could still be slim and trim for the upcoming swimsuit season (I might have had to much caffeine today 🙂 ). So not only was I getting my 1st prescription for MTX on Wednesday, I received my 1st steroid shot too.


I took my first round of MTX last night and I’m happy to report that I have a slight headache that feels like it is from dehydration and that’s it so far. Some of that headache might be caused from watching too much TV this weekend too (I got Direct TV on Friday night and have fully enjoyed all the new channels and movies that I now have access too). My doctor does have me starting off on a low dose and then working my way to a full dose in a few weeks, which might be the reason for no major side effects so far. I’m also the size of a small SUV, which means it takes a lot of anything before I feel much, even Starbucks. Regardless, I’m happy with the med so far and feel no anxiety or worry about my taking this med for an extended period of time.

I know and realize every patient is different. Some patients essentially have no choice and have to take harsh meds like methotrexate in order to continue to live and function. Others, such as myself, have a choice and are taking the med for the hope of a better quality of life. Regardless of your reason, please take the time and effort to educate yourself on all possible options. Not only that know your options 2 or 3 steps into the future. Engaging in my own care is what keeps me motivated and willing to try new things. Change is not scary, sometimes the work associated with that change is though. The only way to combat that fear is to be willing to do work until a cure for this disease is found.




P.S. If you would like to talk to me more about MTX, please feel free to e-mail me at I would be happy to answer any questions or talk to you about med options.


Methotrexate and me… — 2 Comments

  1. I’ve been taking methotrexate for 25 years now with no ill effects from the drug beyond a very slight change in my liver enzymes once years ago. After a few months taking it I switched to injections because I found the gastro-intestinal effects of the pills to be too much for me.

    Now I inject it before I go to bed and wake up with a slightly hungover feeling for a few hours – not bad at all. Good luck with it Andrew. From what I read the maximum dose is 25 mg and I’m at around 18

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