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MTX even with normal inflammatory markers?

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Posted 10/27/2015 4:55 AM (GMT 0)
I've been taking Plaquenil for 6 years with a diagnosis of UCTD and it has made quite a difference in my overall wellbeing. I still deal with flares and have had to learn to manage my energy etc etc. When I've attempted to quit taking it, I end up in an extended flare and have had to resume taking it.

I have been having increased symptoms over the last few months much more fatigue and arthritis type pain in feet and hands and downright muscle weakness at times - all very frustrating.
Just saw rheumy and he suggested I start low dose MTX in addition to Plaquenil. I reluctantly agreed. But when labs came back the Sed rate and CRP levels, though higher than my usual, were still within normal limits. UA revealed protein and blood, but 1 week follow up UA was normal.

My question - sorry about the long post - is whether it's common to start MTX, which Dr said was to treat inflammation, with normal range inflammation markers. I'm a little leery of starting MTX at the start of flu/bug season anyway. Of course I called his office with this question a week ago but haven't gotten a call back.

Just wondering if anyone else has dealt with this - perhaps nl Sed and CRP are not necessarily reliable markers? He did run other antibody tests again and other than ANA all were neg. Any advice or comments would be very appreciated.

Lucy
Posted 10/27/2015 1:00 PM (GMT 0)
Rheumies will start one of the three meds, (Imuran, Cellcept, or MTX), based on symptoms. You say you are having "increased symptoms" and "are still dealing with flares" - that is why he is suggesting MTX.

I have never heard of using these based on blood work -- although it's a good idea. Lupus, being the strange and wonderful disease it is -- well, symptom activity often doesn't match up with what the blood work says, so they have to treat based on how our symptoms are doing. More symptoms, more treatment.

If you aren't around children, I wouldn't worry about flu season. (I'm not around children, or very many people really, have never had a flu shot and haven't had the flu in many, many years.)

Best wishes.
Posted 10/27/2015 6:19 PM (GMT 0)
Thank you, Lynnwood. What you said makes sense. In thinking it through, I also realized I had been using Advil on a daily basis over the years to help manage symptoms, and over the last few mos. have been trying very hard not to use it at all other than the worst of days (largely because of new warnings regarding Nsaids). Probable connection there, and why rheumy has opted for MTX at this point. Although I've been complaining of flares all along, for which he Rx'd Prednisone to use at my discretion - I hardly ever did, just waited things out when I could. I haven't worked in awhile - so that was do-able.

I don't get out much, so my exposure is limited most of the time, but I have a 22 mos. old grandson who lives out of state but comes with his mother (my daughter) several times a year for 3 wks at a time and the next visit falls in Dec./Jan. I don't get flu shot either - every time I have in the past I would inevitably get the flu - 2-3 wks afterward - like clockwork. I seem to fare better without it.

Anyway, thanks again for your thoughts!
Lucy
Posted 10/27/2015 8:37 PM (GMT 0)
Unless your grandson attends a daycare with other children, I'm still thinking that wouldn't be too much of a risk.

What a fun age to have visit!!!
Posted 10/27/2015 11:34 PM (GMT 0)
No daycare - just lots of relatives and a couple nursing homes. Still mulling, but I'm chilling out about giving it a try.

He is uber fun and utterly exhausting! I love their visits and store up all the extra laughter and love - it's like a tune-up for my endorphins. (Even if it does take me about 2 weeks to recover when they go home😜)
Lucy
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