Is starting methotrexate "overkill "

I would say it’s true.

MTX has been around for decades and is considered safe. There are potential side effects which is why folic acid is taken in conjunction with this drug. It’s been excellent and a chemotherapy agent and then some. You can only but try it and see how you feel on it. I wish you the best.

Thank you very much. I appreciate your comment.

Imaging may be very helpful in making your decision to see if you have any joints with active rheumatoid arthritis.

FYI, methotrexate is used for inflammatory conditions beyond rheumatoid arthritis. It is called a DMARD (disease-modifying antirheumatic drug) because it helps slow/prevent bone damage and perhaps other tissue damage. Once damaged it is unlikely to heal properly.

Whether you choose to go on methotrexate can depend on whether your treatment goal is pain management or disease management. Steroids might have been helpful for pain for some folks but not for me as I have type 2 diabetes. I chose to start methotrexate because of my pain levels, and because certain inflammatory markers were elevated. (Note if goal is pain management, the relief will not be immediate, rather it may take several weeks). I was able to decrease my NSAID use as the other agents got to effective levels.

I have seronegative RA, osteoarthritis in various places around my body, and erosive arthritis in my hands. I may fibromyalgia too. I take hydroxychloroquine, methotrexate, and Enbrel for the RA pain. I use oxaprozin and diclofenac gel for the rest.

The images (xray) results were:
"Mild soft tissue swelling along the radial aspect of the second MCP and PIP joints. Generalized osteopenia with no displaced fracture. Minimal degenerative changes at the first and second MCP joints with tiny marginal osteophytes. Other joint spaces are preserved. No periarticular erosions or periostitis."

I'm not sure if this is indicative of RA.

Thank you for your helpful response! I wish you and all the others the best.

I am not a medical professional so I can neither diagnose nor advise an individual on choosing what treatment to take. The imaging alone suggests something is going on.

I will say diagnosis of RA, psoriatic arthritis, etc can be complex and be based as much on what the doctor sees when examining the patient and when looking at all of the test results. These results were the observations of the radiologist which then were interpreted by the rheum in light of the physical exam and laboratory findings.

Getting a second opinion could be worthwhile if what your doctor advises does not satisfy you.

Good luck!

Thanks! I'm trying to get a second opinion. I'll show all the labs etc to the doc, then probably try the drug if both Rheumatologists strongly advise.

I was diagnosed with RA in 2013. I was put on Enbrel injections, Methotrexate and Prednisone. I came off the Prednisone after one year but stayed on the Enbrel and Methotrexate for 10 years.
Methotrexate It started out to be a chemo drug. I was told by alot of people it was very dangerous but the only problems I really have had was hair loss and I was diagnosed with Alopecia so I don’t know if it had any relevance to that. I changed to Rinvoq pills last year and requested to end Methotrexate and I feel the same. I don’t normally have any pain while I am taking the meds. So it wasnt that bad to me. Just my opinion.

@rh1384 Welcome to Mayo Clinic Connect! It’s great that you found the site and decided to join! I’m glad to read that methotrexate wasn’t a problem for you and that you're doing OK.

I took Methotrexate for RA and it caused mouth sores and hair loss. Eventually my doctor took me off of it due to the side effects.