Methotrexate for arthritis and iritis: how long for it to work

[Octobergirl]

I’ve read that Methotrexate can take from 6-12 weeks to work, and I’m wondering for those who are on it, how long did it take for you to notice a difference. I’ve been in a flare for 9 months with the main symptom arthritis with intermittent iritis, but this last iritis flare seems to becoming chronic. I’m on Entyvio with helps me have zero gut symptoms and was also on Imuran, but I started Methotrexate 7 weeks ago and haven’t noticed any difference at all yet it either the arthritis or iritis. Looking for some positive “success stories” to keep my hopes up.

 

[Maya142]

My daughter has both arthritis and Crohn's. For both my girls, MTX worked after about 6-8 weeks or so. But we only tried MTX with a biologic - not by itself.

Entyvio is actually known to have caused cases of new onset spondyloarthritis (SpA) or, if the patient was already diagnosed and their SpA was in remission, it caused a flare. There are a couple of small case studies that discuss this.

When my daughter tried Entyvio, her SpA (which had been doing better) promptly flared, causing severe, debilitating pain. She also developed drug-induced Lupus with it, but that's really rare. It was stopped and we moved on to Cimzia instead.

Have you seen a rheumatologist and have you been diagnosed with some sort of SpA? They may call it IBD related arthritis or enteropathic arthritis, but it's all the same thing - a type of spondyloarthritis.

Other types of SpA include Ankylosing Spondylitis (which is the type both my daughters and husband have) and psoriatic arthritis.

Are you also seeing an ophthalmologist? My husband had bad iritis for a while and it was controlled with prednisone drops.

It is possible you will have to switch to a different biologic - have you been on Remicade, Humira, Cimzia or Simponi? All of those would help with both arthritis and IBD AND with iritis.

Here is the study about Entyvio causing arthritis: https://ard.bmj.com/content/77/Suppl_2/354.1

 

[Octobergirl]

Hi Maya,

Thanks for the information and the link. I don’t think it’s that likely that the Entyvio caused the arthritis flare since I had been on it for 3 years, but I suppose it’s possible. Is there any way to know if it’s the Entyvio causing the arthritis flare besides stopping Entyvio? I wonder if Entyvio has been associated with iritis flares.

I am seeing a rheumatologist and was diagnosed with spondyloarthropathy, but I don’t know what kind. When I firay got sick my SI joint was bothering me, and they took x-rays but I wasn’t ever diagnosed with AS. I have been confused though as I’ve read on many websites that Crohn’s arthritis doesn’t causes deterioration, but then I asked my rheumy and my referred to rheumy and they said it does. Do you know if it’s not AS if it causes joint damage? I guess I don’t understand how anything with long-term inflammation wouldn’t cause damage.

Is your daughter on 2 biologics? I thought I had read that. My GI was ok with my trying to add Humira with Entyvio and Methotrexate but my rheumy thought since there haven’t been any long-term studies she wasn’t comfortable with recommending it. She also said there have been some studies done with other combined biologics and they can cause life-threatening infections. I’m getting impatient waiting to see if the MTX will work though and am worried about joint damage. I also don’t want to get off Entyvio since it’s the only thing that has worked for my gut. I have already been on Remicade and Humira.

How did you husband finally get his iritis under control? I am on steroid drops but this last flare they haven’t completely gotten rid of it.

 

[Maya142]

Hi Octobergirl - I answered your other post but I wanted to address some questions you had.

My daughter is on two biologics. She was on Entyvio with another biologic but not Humira (an IL-17 inhibitor). There is another poster whose name I can't remember but search the forum for "two biologics" or "Entyvio + Humira."

The reason for two biologics was that her AS is severe and she failed all the TNF inhibitors. SO we put her on an IL-17 inhibitor but that can make Crohn's flare and her Crohn's (which DID respond to anti-TNFs) promptly flared.

So she first tried Entyvio + the IL-17 inhibitor. Entyvio just made matters worse for her because her joint pain became worse and she also got drug induced Lupus.

Then we switched to Cimzia in place of the Entyvio with an IL-17 inhibitor for the arthritis.
There ARE studies on Entyvio with an anti-TNF - that is a combination that is actually in trials I believe.

We did have to fight hard to get two biologics - the insurance company was not happy. Our rheumatologist and GI only agreed because she had failed everything else and clearly still had joint inflammation and damage occurring (she has had 3 surgeries in the last year).

My husband's iritis was just controlled with drops...it was not so bad.

Axial SpA DOES cause joint damage. Axial SpA is divided into two categories - AS (where you have SI joint damage already on x-rays) or non-radiographic axial SpA when you inflammation in your SI joints or spine that does not show up on x-ray but does show up on MRI/CRP etc.

Peripheral SpA can and does also cause damage, but it sounds like you have axial SpA if your back is involved.

I will tag my little penguin in case she has any other ideas for you...her son has peripheral SpA diagnosed after the Crohn's was diagnosed. In his case too, it did cause damage to his tendons.

 

[Octobergirl]

Hi Maya,

Thank you for your replies. I'm so sorry that your daughter has been through so many issues with her disease and drugs. Are her joints and Crohn's now in remission with the combined biologics? Have you noticed her being any more susceptible to picking up illnesses since being on them?

How long does it take for enough damage to occur before surgery is needed? I'm starting to get really anxious about the damage the inflammation is causing. When the MTX started working for your daughter (I know she was also on a biologic), was it a gradual change or did she notice it right away?

I'm really starting to get discouraged. I'm not even sure my insurance would cover two biologics either, and I'm really hesitant to get off Entyvio since nothing else has worked for my gut long term. Remicade worked for about 2 months and Humira only kept my arthritis and extra-intestinal symptoms at bay. I guess the only other option I have if MTX doesn't work is Stelara if I can't get an additional biologic. I'm afraid it will be the same as the other biologics where it works for either the gut or extra-intestinal symptoms but not both.

 

[my little penguin]

Ds is on two biologics as well
One Stelara for Crohns /JSpA plus mtx
High dose 90 mg every 4 weeks does work for the most part for his gut and joints
Mtx takes 8-12 weeks to work
He aslo takes nsaid -Celebrex for his joints

Other biologic is for his Sweets Syndrome - anti tnf (remicade /humira ) and Stelara (il12/il23) did not stop it
So he takes an Il-1 blocker

Good luck

 

[Maya142]

No issues with illnesses. Her joints have been monitored by ultrasound and MRI. She has been diagnosed with the disease for 10 years now, she's probably had it for 15 years. She does have aggressive arthritis, so it has caused more damage than some patients' arthritis. I will say she had some damage at diagnosis - at 12 years old. It's taken till 18-19 before she started having surgeries.

Older daughter has some damage, no surgeries. In her case, biologics have worked better and her arthritis is less aggressive.

MTX worked in 8 - 12 weeks.

 

[Octobergirl]

Thanks MLP and Maya.

Maya, I’m glad your younger daughter hasn’t had any issues with more illnesses. I’m so sorry her disease has been so aggressive and at such a young age.

I guess I’ll just try and wait it out with the MTX for another month or so. I’m on my 8th well so I’m hoping some improvement takes place soon. I’m assuming the improvement is gradual since it works so slowly.