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How is methotrexate supposed to help?

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So I was put on methotrexate, I'm on week 6 now.


I'm not seeing any differences, if anything I've been feeling worse.


I take it on Saturdays and by Sunday night I am so tired, I can't' do anything.


First few days at work are also extremely tough for me, I tend to feel better towards the end of the week.


Is it supposed to reduce inflammation? Or just kill off my immune system, and then let it built itself back up later once I'm off?



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I have been on Methotrexate (MTX) with folic acid since February and I understand it is supposed to reduce pain and inflammation in the joints and improve daily physical function. I am not sure how it is supposed to suppress the immune system, but I know that blood tests are generally required to make sure it doesn't cause damage to the liver or other internal organs. It is normally prescribe for arthritis, but is commonly used for scleroderma.


I was diagnosed in January very quickly, so I am uncertain how I would have felt had diagnosis not been made so swiftly. I do know that I haven't had side effects from it, and my joints are not swollen and painful as they were except in my feet (where the disease first made its outward appearance).


Hopefully, someone with fuller knowledge of the drug can shed more light.


Kindest regards,



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We have a section on Methotrexate (MTX) that you might take a look at. It provides links to patient information pages about the drug as well as how it works and how successful it is.


As Honey mentioned it is prescribed to treat arthritis, so since scleroderma is a type of an arthritis, it is commonly prescribed for it. According to the American College of Rheumatology (ACR), MTX is "a disease-modifying antirheumatic drug (DMARD) because it not only decreases the pain and swelling of arthritis but also can reduce damage to joints and the risks of long-term disability." It also states "it is not entirely clear how methotrexate decreases the severity of arthritis. " So even the doctors don't know!


I was on MTX for 3 years. It was the first medication I was placed on and it did a great job of slowing down the progression of my diseases (sclero and polymyositis). I didn't suffer from joint pain or swelling so I couldn't use that a marker as to how it was working. I do know that it was a couple of months to start to reduce the heavy fatigue I was suffering from and the many other disease related symptoms. So give it a few more weeks.


Yes it does suppress the immune system and some people have to stay on it for years in order to keep the immune system suppressed, preventing it from doing further damage. It doesn't necessarily "come back correctly" when you quit your medications. I've been on an immunosuppressant of some kind for over 5 years now to keep my immune system from damaging any more body parts. :)


Are you taking folic acid? If not, please talk to your doctor about that. Folic acid is usually prescribed with MTX, because according to the American College of Rheumatology (ACR), MTX can hinder the production of a form of folic acid. I do hope you start to feel better. If you don't, you should mention it to your rheumatologist.


Big Hugs,

Janey Willis

ISN Support Specialist

(Retired) ISN Assistant Webmaster

(Retired) ISN News Director

(Retired) ISN Technical Writer for Training Manuals

International Scleroderma Network (ISN)

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Hello Omaeva. I have been on Methotrexate since January 07. I did feel more tired and "beat down" when I first started taking it, but that did improve. My fatigue improved as well as the rheumatoid arthritis (RA) in my hands and feet. I also take plaquenil so I don't know if one contributed more than the other. I have increased from 10mg to 25mg since 2007 and now I don't have any effects from it. I still take it on Saturday just in case I need some extra rest on Sunday.

I may have Scleroderma, but Scleroderma doesn't have me!

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Hello Omaeva


Good question. I have just started methotrexate, after the first dose I slept 20 out of 24 hours 4 days later and after the 2nd dose don't feel quite as tired as with the first dose. Good thing really because I couldn't continue with it at that level of fatigue.


I am hoping for big things as I couldn't tolerate the mycophenolate any longer and am not sure where I go from here if I don't get on with the methotrexate.


I'd also like to know when it will really start to work but I'm guessing the answer will be as it always is with anything sclero, no one knows as everyone's different.


Take care.

Amanda Thorpe

ISN Sclero Forums Senior Support Specialist

ISN Video Presentations Manager

ISN Blogger

(Retired) ISN Sclero Forums Assistant Manager

(Retired) ISN Email Support Specialist

International Scleroderma Network (ISN)

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