• Amy Suto

Methotrexate vs. Xeljanz: RA Medication Showdown

As with any post on this here blog, I'll start by saying that this post just represents my experiences and that's it. I'm not giving medical advice, always check with your doctor about that!

If you've been diagnosed with RA, you'll probably do what I did: immediately turn to Google and start learning what the hell is going on.

I remember being in my LA apartment, sitting in the sunshine on my deck as I read all of the horrible side effects of methotrexate, the first drug usually recommended to treat rheumatoid arthritis.

If you're scared -- that's okay. These drugs can be scary at first, but with any luck they'll help you on the road to recovery.

RA Meds: Starting on Methotrexate: 10-20mg/week

I remember reading through all the info about my new meds at my kitchen table in January 2021. I was starting on steroids for a few weeks before tapering off, and then I'd begin methotrexate, increasing until I got to a 20mg dose.

At first, I didn't have any side effects for the methotrexate once I began. But when I started getting close to 20mg -- all hell broke loose.

It was around 15mg that I started getting nausea that would last for days after I had taken my weekly dose. I also felt zapped of any energy, which could be from either the medication or the RA itself.

And then -- my hair started falling out. It wasn't dramatic, it was slow and happening over time. But one day I woke up, looked in the mirror, and realized that a part of my hair felt much thinner than it had in the past.

I'm not going to sugar-coat it: this was awful. I felt like the medication was taking away more than it was giving. I wasn't seeing any results: my swelling hadn't gone down after the steroids wore off, and my joint pain hadn't really reduced.

I told this to my doctor, and he reduced my dose to 10mg/week.

I wanted to highlight this to you because a lot of people don't think it's okay to complain about their side effects to their doctor and ask for a change.

That's not true: you need to advocate for yourself as a patient. If your side effects are hindering your quality of life, it may be time for a new course of action.

I also turned down my doctor's suggestion to go on methotrexate as an injectable, which could have circumvented some of my side effects.

In my mind, the methotrexate hadn't worked at all. I was ready to try another way.

RA Meds: Starting on Xeljanz at 11mg/day

After I had "failed" methotrexate, it was time to try a new drug.

In this case, a biologic known as Xeljanz. It took me a month and a half to get approved and get all the insurance sorted out (there's a lot of annoying co-pay stuff with Xeljanz because it's so expensive) but eventually I got on 11mg/day.

It's been barely three weeks since I started Xeljanz, but it's already worked wonders: my swelling is down, the joint pain in my wrists is minimal, and my blood tests are getting better and better.

Weaning Off of Methotrexate

It's now time for me to wean off of my methotrexate -- but this happened, once again, because of patient advocacy.

My nutritionist was the one who suggested I ask my doctor to take me off my 10mg/week dose after the Xeljanz started working.

That's the problem with chronic care: you still need to ask your doctors for things that will help you, because they're not necessarily keeping track of these things for you.

I'm excited to get off of the methotrexate completely: I'm hoping that my fatigue and hair problems will start to get resolved as things change.

It's still early to tell, but I'm optimistic about feeling closer to normal.

Here's wishing you smooth sailing in your drug trial-and-errors!