Methotrexate Nausea

[Eve]

Just a quickie if Sqad or anyone knows?

I've started having what I figure are side effects to the methotrexate with upping the dose so trying to figure ways of reducing them as much as possible to keep on it to try and get some kind of relief from my arthritis. I've had a near constant headache, more grumbling though, not severe (not as bad as a sulfasalazine) and really bad nausea and evil heartburn.

I'm on omeprazole and can take paracetamol and such. Am I ok using the stemetil I have for my menieres for the nausea (though I'm not sure if it's connected to the heartburn?) or is there something better I could try. I have been using it and it's helped a little. At rhumo on Tuesday so can ask them then.

Got some new sticks from physio today, the ones which are moulded for your hands to reduce pressure so got one for each hand and they are great :) Still worried that my hips and knees seem to have gone downhill so fast but will see what they say next week, pretty worries about joint damage now.

[EcclesCake]

I've found ginger tea or ginger beer help with nausea.

[Eve]

Thanks Eccles :) I've tried ginger biscuits in the past but don't think I could stomach them at the moment, will try tea.

I love ginger beer though fizzy would be bad for me at the moment with the heartburn and still suffering with burping a lot after having my gallbladder out. I could let it go flat though.

Still, I've lost nearly a stone so it's at least countering some of the effects of the steroid munchies from when I was on them so bit of a silver cloud and all that :) I bought some ring doughnuts with hundreds and thousands on as a post physio treat earlier but can't face them either. Been mainly eating wraps and salad and lean cold meats and such, bananas, little cereal bars, muesli on the weekends.

[bednobs]

when i was on mtx and had that constant nagging nausea, i used to find the only thing that helped was eating (constantly) i used to basically eat a slice of toast very hour or so. Eventually i was moved to mtx injections

[bednobs]

ps i hated those splayed hand crutches - they are so much heavier than ordinary ones

[NoMercy]

I presume you're on 15-20mg once weekly with 5mg Folic Acid 3 days subsequent to the Methotrexate?

You could try splitting the Methotrexate into two doses or upping the Folic Acid to 5mg daily for 6/7 days (everyday apart from the day you take the Methotrexate). The other option is subcutaneous Methotrexate which could confer less nausea and GI side effects.

This can only be done with the consent of the Consultants. Do you have a Rheumatology Helpline number?

[Eve]

Thanks bednobs, I've been trying to graze, especially being at work so early, things like a banana and currently loving those Belvita breakfast biscuits, even something drier like a croissant, and drinking loads.

I had the clumpy NHS style stick to try the last week and my physio gave me a try with the hand ones and they seem lighter and almost easier to grip with for me (than the NHS usual one anyway), a bit like having your hand held haha :) They seem a bit smaller too.

I had a look in the mobility shop where they do Shopmobility the other day but the walking sticks I tried in there had really hard plastic handles and felt really uncomfortable. My wrists aren't great though wearing tubigrips on them helps a lot at work as long as I don't put too much pressure on them. I got myself a rucksack too which has really helped and a little over the shoulder bag as well to keep my purse close as it's such a faff taking it off to get in it (especially with impatient people in queues) and I feel safer as been feeling a bit vulnerable having it on my back, especially round here.

It does worry me how bad my hips especially have got so quickly, did you find things would just go a bit mad like that?

[Eve]

Hi NoMercy. I'm on 15mg a week, I take it on a Friday before bed then my folic acid on a Monday.

Ahh, more folic acid could be an easier solution - will sound out rhumatology. They do have a helpline number, I rang the other day to see if there was anything better I could do for the hip pain as codydramol aren't helping much and I can't take NSAIDS. The nurse was going to speak to my consultant though it may be that everything waits until Tuesday when I see them as not really an emergency (albeit crappy for me) and I don't want to bother them again so soon.

Is subcutaneous when they inject it? I was wondering if they do enteric coated ones (mine aren't) as I've had problems with non-enteric coated things before.

[bednobs]

yes, definately, although it was always just before i needed a hip/knee replacement. I don't wish to scare you though :)
not that this will make you feel any better, but the replacements were the best thing i've ever done for my own health and have given me a great qualit yof life back.

[bednobs]

yes it's a s/c injection that you do yourself

[Eve]

Oh, well, I can't say I wouldn't appreciate some new hips (knees, wrists, shoulders, hands...) for Christmas! :) To be honest, the way things have been going downhill, if it meant I could start getting my life back. I'm hoping it's something more fixable (though it doesn't feel much like it at the moment). Just so uncomfortable, sitting, trying to get to sleep etc... let alone getting about or bending.

If you don't mind me asking, how old were you when you had your replacements? I don't think you're that much older than me are you?

[bednobs]

if you were born in 1978 as your name suggests, i am 4 years older than you. Hip 1 was when i was 32, knee 1 was when i was 35, hip 2 when i was 36 and knee 2 when i was 37. Hip and knee 2 should have been done in 2010 but 2 children kind of got in the way :)

[Eve]

Wow, you're like bionic bednobs :) ! Yes, it's my birth year, I was 34 last month. Cheesy at it may sound though, you do give me hope :)

I'm hoping the methotrexate will kick in big time soon. My hands are a lot better which I find a bit random as other things are going a bit wrong, joints, eye inflammation etc... My ESR has gone down a fair bit too and stayed down for my two last bloods screens so it looks like something is working somewhere.

[bednobs]

it's rather annoying isn't it when your bloods look good but you feel rubbish? As i said before, i'd rather have it that way round than the other though.
Don't get me wrong, having joint replacements is rubbish, but so much better when you've recovered than before. my second knee isn't as good as the first one, but it's so much better than it was before, that i'm quite happy to take 80% rather than 100! They offered me a revision (manipulation under anaesthetic) cause i can't get it straight but i politely declined

[NoMercy]

Are your inflammatory markers (ESR and CRP) still elevated?

It certainly sounds like the arthritis is active at the moment.

I wonder if Tramadol might help?

[Eve]

It is. I've had impromtu Arthritis Awareness week at work with all the "ooh what have you done" comments. Though never a bad thing to get information out there, especially as the next question is usually about whether this cold weather affects my joints and when you reckon you're getting funny looks for moving about as if you don't move you probably won't be able to move for a while :)

[Eve]

I don't really hear much about my CRP though don't think it tends to be that raised, even when my ESR is, but I'm not sure. My ESR is always raised though has been down lately since going on the methotrexate.

They found disease activity in my hands last consultant appointment on ultrasound despite a week of being on 40mg of pred daily which was when I was put on methotrexate. They think I have arthritis related dry eyes, maybe Sjogrens, and I've developed episcleritis in both eyes so on steroid drops for that and, not sure whether it is related, but kidney results have been a bit weird so had some bloods and urine tests done yesterday and been referred for a renal scan.

Does tramadol knock you out? I've been scared to ask about it because of that though it does take a bit to knock me out :) I was also loathe recently as I'm also on pregabalin and it made me really sleepy initially though that effect has worn off now.

[bednobs]

i used to take long acting morphine and it never knocked me out. Perhaps if you are worried about being knocked out, a regular delivery method (eg temgesic patch) might help? I had that too, and it was FAB

[NoMercy]

We see a lot of Sjogren's with SLE or schleroderma overlap.

I think primarily you should speak to one of the Consultants or CNS team regarding the Methotrexate-related nausea and see what can be done about that.

Hopefully the arthritis will become well controlled before long.

[Eve]

Here's hoping :) Hope you are enjoying being in rhumatology, sounds like you have picked up loads!

I will definitely ask about pain relief when I go see them next week. It's all go at the moment with OT, bloods screening yesterday, physio today, gastro tomorrow then rhumo and eye clinic next week, hopefully I can be a bit more sorted for Christmas :) Be good to have a more relaxing one after gallbladder hell last year.
Ok, off to sleep for me, didn't realise the time! Got to go ice my foot, banged it on desk trying to get up a couple of months ago now I think and still very sore on thr top and swollen, nice physio went at it with sdome needles earlier for me.

Scuse weird spellings, on my phone in bed and it isn't keen on the text thing on here, won't let me edit well.

Thank you both so much for all your help, I really appreciate it. Night x

[Sqad]

Jenna....I cannot improve upon the suggestions bt NoM......taking the drug after your evening meal, liting the Friday dose or perhaps using the Stemetil daily and perhaps doubling up on the dose.

I agree if all fails your. methotrexate will have to be given by IV or subcutaneously.