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Anyone on both Methotrexate and Prednisone?

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Posted 2/4/2014 2:49 AM (GMT 0)
Hi, I have MCTD and the lupus end of the mixed connective tissue disease has been causing pleural effusion of my right lung. I had a thoracentesis to drain fluid off my lung but am filling up again. Initially it was thought that I had pneumonia or malignant pleural effusion but the fluid is not infectious or cancerous. I did have lung cancer a year and a half ago...adenocarcinoma of the right lung. I had to have the lower lobe of my lung removed.

Both my rheumy and pulmonologist are working together to try to get this under control. The pulmonologist put me on 40 mgs of prednisone right after the thoracentesis. I was on that dosage for over a month. I'm currently weaned down to 20 mgs and will stay at that dosage at least until i see my pulmonologist again in just over a week.

I had been on Methotrexate for over 5 years and it was stopped in November because the Doc's thought I had pneumonia at the time. Tomorrow I will be starting it back up again, taking a weekly dose of 10 mgs. I've tolerated MTX well and it did help with my symptoms. My body sort of went hay wire this past Fall. I'm anxious to get off the prednisone...I hate the side effects. Just wondering if anyone has taken MTX along with prednisone before. Just concerned about having this combo in my system.

Anyone else with lung issues due to lupus? What type of treatment are you recieving?

Hugs, Robin
Posted 2/5/2014 3:59 AM (GMT 0)
Hi Robin:

I'm sorry to hear about your issues with the cancer in your lung. That's a really hard thing to cope with I'm sure. I know currently I'll be having my second PET/CT next Wednesday of my lungs. I've developed several nodule in my right lung that my pulmonary dr doesn't like the look of them. On my first PET/CT they all lit up like Christmas tree lights. Will see what happens next week.

To answer your question, I take both Pred and MTX and have been doing do for almost 4 years now. I did take a period of time off to try Benylsta for like 7 treatments but went back onto MTX. I've never been able to get below 10mgs of pred a day, and that only lasted for 4 weeks I think it was.

I'm currently on 20mgs of pred daily and I'm taking 35mgs of MTX weekly. I'm taking more MTX than a normal lupus patient would. I'm doing that because I developed T-cell LGL Leukemia, not sure exactly when, but it was made officiial in May of 2013. This type of leukemia is seen in patients who have RA and autoimmune disease. I have both the RA and my lupus so my Dr wasn't surprised to see the leukemia show up.

There is NO cure for this type of leukemia, they can treat the symptoms only. The drugs that they most commonly use are Prednisone, Cytoxan, MTX, and Cyclosporine. I have already taken ALL of these drugs to treat my lupus and RA. I can not take Cytoxan again because I started showing changes in my bone marrow for MDS. I'm allergic to Cyclosporine, so that leaves MTX and Pred.

When I'm on lower doses of MTX I have very few side affects taking both medications together. Now that I'm on a bigger dose of MTX, I've had issues with mouth ulcers, nausea and vomiting, fatigue, and generally feel poorly. My oncologist is planning on raising the amount of MTX as high as I can take to keep my leukemia under control. My Rheumy is worried I've already maxed out on MTX and I'm now starting to have kidney issues.

Oncologist disagrees and said my kidney issues aren't related to the MTX. So I'm really confused at the moment. Anyway, I didn't have any problems with PRED and MTX. If you have any questions at all, please feel free to ask away. I hope and pray that it helps you and you get home soon.

Hugs,
Barbara
Posted 2/5/2014 3:53 PM (GMT 0)
Barbara,

Thank You so much for your response. I am so very sorry about your situation. I do not usually post on this forum. I went back and read posts about your recent time in the hospital. So glad you are home! You are one strong and brave woman, I do appreciate you taking the time to respond to me. You have a beautiful spirit!!!

I do understand about feeling like you are between a rock and a hard place. Many of our meds can cause such horrible side effects on their own. Most of the meds I take have a moderate or major risk of using them together. The docs feel I'm in a special circumstance category. I see that we both have lung and heart issues. A bone marrow biopsy was done in the past because of blood issues. Thankfully that resolved itself.

Shortness of breath is my biggest concern and filling up with fluid. The fluid they drained off my lung was bloody. If I continue to fill up, an exploratory surgery will be needed. My pulmonologist is somewhat sure the fluid is not due to malignant pleural effusion. The prognosis for that is very poor, usually 4-6 months...he thinks I would be a lot sicker if it was. He is treating it as lupus related....lupus attacking the lung pleura ... I guess time will tell.

Last night, I took my first dose of MTX after being off since November. I awoke feeling about the same, crappy...lol :) Hoping a few more doses and I will start feeling better.

Barbara, you are in my thoughts and prayers. Wishing you the best as you take it one day at a time. Thank you for reaching out...it means a lot to me. Hoping your docs can come to an agreement about the best treatment possible for you. I will be praying that an answer will be found!

Hugs, Robin
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