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Doctor insights on: Efficacy Of Methotrexate Treatment In Lupus

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I was recent diagnosed witj lupus which is attacking my liver and kidneys. Is methotrexate safe to take if my liver is already messed up?

I was recent diagnosed witj lupus which is attacking my liver and kidneys. Is methotrexate safe to take if my liver is already messed up?

Possibly not safe: Mtx should be avoided in active liver injury. It should also be avoided if you have abnormal renal function as it can accumulate in blood and cause increased toxicity. Would recommend discussing these issues with your rheumatologist. ...Read more

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Methotrexate (Definition)

Methotrexate was originally used in the early 1950's as a treatment for cancer but was also found to be effective in many other diseases including rheumatoid arthritis and psoriasis. It has anti inflammatory and immunosuppressive properties which make it an excellent first line therapy for RA ...Read more


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Past md said not lupus flare because normal labs at time of flare.New md put me on methotrexate.Flare stopped.Wouldn't it not work if not autoimmune?

Past md said not lupus flare because normal labs at time of flare.New md put me on methotrexate.Flare stopped.Wouldn't it not work if not autoimmune?

Lupus Flare: Lupus flares are diagnosed based on symptoms. Labs sometimes help... But often they do not. Finding new markers of a lupus flare is an area of active research now. Therefore your doctor put you on Methotrexate because they thought your symptoms were from a flare (autoimmune), despite the normal labs. ...Read more

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If I have lupus and primary billary chirrosis, will methotrexate help both?

If I have lupus and primary billary chirrosis, will methotrexate help both?

Possible, but....: If you take mtx, make sure it is prescribed subcutaneously, since avoids high-concentration-first pass through your liver. Other options are pulsing with dexamethasone, taking oral hysdroxycholoroquine, oral gold, cellcept, (mycophenolate mofetil) and benlysta. This an issue for rheumatology and gastroenterology practitioners. ...Read more

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I have no organ involvement in my lupus but its just a matter of quality of life, am i putting myself at great risk by starting methotrexate?

I have no organ involvement in my lupus but its just a matter of quality of life,  am i putting myself at great risk by starting methotrexate?

Some risk: Methotrexate (mtx) is not a great risk but there is some risk and you absolutely must use contraception if you re sexually active. If you have failed Plaquenil and you still have serious quality of life issues such as fevers, fatigue, joint pains, etc., it may be good to consider mtx or benlysta (belimumab). Pain and fatigue can change your social life, home life, sex life, and work life. ...Read more

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Someone told me that methotrexate dose use for lupus is no big deal & pts on it are not considered immunocompromised. I'd appreciate your opinion.?

Someone told me that methotrexate dose use for lupus is no  big deal & pts on it are not considered immunocompromised.  I'd appreciate your opinion.?

Get routine checks: Regardless of the dose, this drug can cause compromise- varying from paient to pateint.Testing is rather routine and can spot a problem before it becomes serious. ...Read more

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If lupus went into remission & i no longer needed methotrexate, would it likely cause leukopenia or not?

Lupus can cause leukopenia: Lupus can cause leukopenia. Methotrexate can cause leukopenia. So the reason you might have it depends on the rest of the manifestations of your lupus. Other reasons besides Methotrexate lupus can also cause leukopenia. Thus your evaluation would try to clarify all of this. ...Read more

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After about how many weeks do you stop noticing improvement with methotrexate 4 arthritis or lupus where max improvement is reached? ~12 weeks?

After about how many weeks do you stop noticing improvement with methotrexate 4 arthritis or lupus  where max improvement is reached? ~12 weeks?

Yes: Three months is reasonable to expect the maximum response to Methotrexate at the specific dose you take. If you still have issues, consider increasing the Methotrexate dose. 25 mg weekly is generally considered to be the maximum weekly dose for the conditions you mention. ...Read more

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On15mg methotrexate weekly for lupus. It is normal for WBC to vary much (8.0 e3/ul one week, 2.0 e/ul the next? Is that normal for normal person?

See below: That is a little unusual for the counts to vary that much in two weeks time. If the counts were drawn further apart, a decrease in the white blood cell counts could be explained by an increase in Methotrexate dose, viral infections, or reduced clearance from your body due to kidney weakness. Depending on the above, your doctor may reduce your dose of methotrexate. Hope that helps. ...Read more

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On methotrexate for lupus. I tend to feel great when my WBC is below normal range (2000) & have symptoms when it's normal (8000).Why?Is that common

See below: When you lowering your white blood cell counts that low, you are reducing inflammation as inflammatory cells associated with your disease. However; to reduce your cell count to that level puts you at considerable risk for infection and other complications. Your rheumatologist can come up with other options for you that will hopefully not lower your white blood cells counts down that much. ...Read more

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Can the typical dose methotrexate used for lupus increase ones chance of developing cancer? I'm worried about it. How many years is it "safe" to be on?

Can  the typical dose methotrexate used for lupus increase ones chance of developing cancer? I'm worried about it. How many years is it "safe" to be on?

Very, very, unlikely: The dose is so small on the doses of mtx used for other things, other than arthritis an autoimmune diseases, it is something you should not worry about! ...Read more

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Dr. Robert Lowe
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Rheumatrex (Definition)

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