Methotrexate is the “gold standard” of RA treatment—or so said my rheumatologist back when I was initially diagnosed. He worked hard trying to get me to start taking it by telling me of its huge success rate, how it was well-tolerated, easy to take, and just really “no big deal”. It’s not that I believe he did not have my best interest at heart. He believes in what he does and is very good at it. He didn’t want to see me crippled with RA and the quickest way to avoid that, or so he was taught by the ivory towers of traditional medicine and, therefore, believes, was to get me started on Methotrexate.

Unfortunately for him, I was already familiar with Methotrexate. This was going to be a very difficult sell for him.

I’ve heard no end of horror stories from people I know who either have taken it or continue to do so. About the numerous side effects including but not limited to hair loss, nausea, extreme fatigue etc. One woman said that to spite the side effects, it kept her thin. She had diarrhea all the time, but whatever. This appalled me. I’ve had an eating disorder, so comments about weight have a tendency to set me off. We’re worried about our weight so thank goodness for the need to ingest a chemotherapeutical agent? And we’re not worried about not absorbing nutrients properly since we live with constant diarrhea? Wow, somehow the logic escaped me.

The people I have known who have used Methotrexate also say that they needed to cycle it with other RA drugs because it lost its efficacy over time. This always interested me. It’s also part of the reason I was so against getting started on the pathway of drugs. Watching these women, I know that pathway never seems to end, AND they are still in pain and deteriorating.

Eventually, my rheumatologist began to speak in more realistic terms when he was unable to get me started on Methotrexate before our trip to Japan in fall of 2012. He started to talk about failure rates, the use of supplemental drugs etc. I wish I could remember the specifics (not even my partner recalls), but what interested me was the change in tactics and particularly the change in how Methotrexate was viewed. It might be the gold standard, but that position was also propped up by a host of other treatments including pharmaceuticals as well as over-the-counter anti-inflammatories.

When reading about Methotrexate I found the following:

• While the role in folate as a cancer treatment is well established, its long-term effectiveness is diminished by cellular response. In response to decreased tetrahydrofolate (THF), the cell begins to transcribe more DHF reductase, the enzyme that reduces DHF to THF. Because methotrexate is a competitive inhibitor of DHF reductase, increased concentrations of DHF reductase can overcome the drugs inhibition.

This, to me, is very cool. So we purposely break the folate cycle by eating Methotrexate (a folate antagonist), and the body’s response is to work around that biochemically. It makes me smile. Our bodies are SO impressive.

It also explains why the people I know may be having to cycle it with other drugs. It ceases to work because their bodies work around the drug.

Note: If you use Methotrexate, and it is working for you, I am pleased. I speak only of my personal experiences and do not mean to diminish another’s experience.

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