Nervous about MTX...hlab27+

[AMYH]

Hi Mike and everyone,
I am so happy to have this support. It's my first time posting but I have been reading for a year now when I had my first uveitis flare. I'm 37 yr old busy mom and wife that began having uveitis flares this time last year. My first flare was significant and had to be controlled with durezol. I tapered, had one minor rebound flare but tapered again and did well until October 2014 when I had another mild flare. It was controlled with pred forte this time, tapered and quiet for a couple of months which brings me to my current flare. This one has been again unresponsive to pred forte so I am on durezol and currently tapering. I met with a rheumatologist last week and was also given a steroid shot of keno log- in the hip. I'm hla b27 positive with no other arthritic symptoms. I have noticed some heartburn/acid reflux that preceded this flair so I've also started on a probiotic and protonix. The rheumatologist and I discussed options such as MTX and Imuran to address any other source of systemic inflammation that could be triggering these flares. She preferred the Imuran but I wanted to try MTX first since I can inject it and bypass the GI system. In my research it also seems to be less threatening as far as side effects are concerned. I started last night on .6 ml...not sure how many mg that is. I waited for some sort of exorcism or something after reviewing on line reviews but so far I feel fine which I'm happy about...not sure if the side effects kick in later or what. I'm also under the care of an ophthalmologist who seems to be experienced with uveitis and has been very on top of things as they happen. I do find I have to advocate for myself in this process and do my own research. My mother, aunt, and cousin have all had bouts of uveitis and are hla b27. Their episodes typically coincide with another type of systemic issue like back pain, colitis, etc. I have had no other issues we can pin point which is good but also baffling. So here I am..scared about the MTX as it's a big gun drug but know that I cannot continue to have flares. The dr. Describes my prior inflammation as significant but controllable...but I just can't continue doing the drops, living at the dr's office for pressure checks, etc. I have some posterior synecheue but no other permanent damage we can see at this time. Thank you in advance for insight, support, and ideas. I feel so alone in this!!

[Mike Bartolatz]

please see my response to your introduction. your arthritis and GI issues are directly linked to the HLA B27 gene. the GI issues can impact the entire GI tract from your mouth to your colon etc. when Crohn's disease and ulcerative colitis are involved. large joint arthritis can also be found with or without spine and sacrum involvement. the Methotrexate takes about six months to start showing benefit so be patient as the doctor increases up to about 12 1/2 units which would equal about 25 orally. make sure you take your folic acid the day AFTER you inject so that it doesn't interfere with how MTX works. you might still have some GI distress and hair loss too. you can take Zofran for nausea if needed.

wish you the very best,
Mike

[AMYH]

Hi Mike, thank you for your reply. I have no symptoms of arthritis at this time..just the acidic feeling in my stomach which the dr. Prescribed protonix. It seems to be helping although I still have a little discomfort after meals. I am taking the folic acid on all days I do not take the MTX. At the present time I feel the uveitis is controlled so all of this is mostly trying to prevent future occurences and also finish successfully tapering. My biggest issue right now is anxiety about my situation and the MTX itself which is effecting my sleep. Ambien isn't even working for me! And I need sleep to recover...hopefully tonight will provide some rest.

[Mike Bartolatz]

I do hope you can get some sleep tonight. hopefully it is just the anxiety of dealing with uveitis and starting the MTX.

take care,
mike

[AMYH]

Hello again! I've had a couple of happenings and wanted some input...I'm currently in my 4th week of MTX injections and noticed a couple of days ago an itchy red rash on my elbow. I tried some hydrocortisone and it hasn't helped so I googled and I think it's psoriasis! I've never had anything like this before..I know it's related to me being hla b27 positive but I find it odd that it's flaring now, after I've been on MTX for a few weeks. I'm still tapering off durezol, pressure good, no more inflammation. ugh, now I have this to deal with! Any thoughts?

[Mike Bartolatz]

contact your rheumatologist with this new symptom which could well be psoriasis. after a few years, psoriasis turns into psoriatic arthritis in many individuals so you can start having inflammation of joints and you can develop spinal inflammation. GI problems can also occur when you are HLA B27 positive. you may have to add another drug such as Remicade or Humira to the mix or switch to a drug such as Stelara, ustekinumab or Cosentyx, Secukinumab both approved to treat psoriasis if the drugs mentioned don't stop the psoriasis. controlling the underlying psoriasis is key to getting your eyes quieted down, off all steroids without inflammation. I am glad you are getting good care too. are you taking folic acid to help with MTX side effects, you don't mention this. it is taken at least 12 hours or so after taking the MTX. read up on GI symptoms of Crohn's disease and ulcerative colitis which occur sometimes with HLA B27 positive patients and about psoriatic arthritis. any changes in vision should also be brought to the attention of your ophthalmologist right away. the middle and back of the eye can sometimes become involved, not just the iris and ciliary body. any flashes of light, increase of floaters etc should make a call necessary and a follow up appointment to make sure the retina is ok.

wish you the very best,
Mike

[AMYH]

Hi mike, thank you for the reply. Yes, I'm taking folic acid as you indicated. So far, I'm tolerating the MTX very well and have added biotin to hopefully prevent the hair thinning. The rash is only on my elbow and doesn't have the plaques psoriasis most often has. I see my rheumatologist on Monday I'll know more then. I also see my opthamologist every 2 weeks as I continue to taper. So far, so good! I'll keep you posted.

[Mike Bartolatz]

Glad you are doing well on the methotrexate. perhaps it is eczema on your elbow. this can be linked to inflammatory cytokines linked to uveitis through IL17. but, there are different types of psoriasis and even rashes liked to other things such as sarcoidosis so if it continues you might want to get it biopsied to figure out what it is. sometimes we have more than one underlying condition going on not usually linked to the HLA B27 gene such as sarcoidosis.

wish you the very best,
Mike