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Hello,
Can one follow a regime in which MINO and MTX courses are running simultaneously? My brother is on MINO since last 3 years and hasn't seen any significant improvement. Everybody is suggesting MTX. Please advice.
Thanks
Hi Mahesh,
Just wondering…is your brother able to get brand name minocin in India or does he use generic minocycline? Some people report better success on the pelletized brand (made by Wyeth and distributed through Triax here in the US and Stiefel in Canada – much cheaper to buy in Canada).
Although some people also do well on generic minocycline (Teva and Watson come to mind), not all generics are equal and some may be allergic to the fillers.
The other question that came to mind…is your brother daily dosing or using pulsed dosing? With the approval of his doctor, changing up the protocol one way or another may affect his progress for the better.
Has your brother thought about adding a second antibiotic? Dr Brown felt that some people's progress was impeded by strep, for instance, and recommended that this be treated until strep titres came down to normal levels. He said that patients prone to nodules were particularly prone to strep.
Lastly, there could be any number of other things impeding your brother's progress…leaky gut with food sensitivities and candida come to mind, but others may be able to add other ideas. Dr Brown felt that people with RA were in a hyper-sensitive state, so ruling out anything that may be triggering flares (stress, gluten, dairy, red meat, etc.) may help, too. A Friend posts here often and has shared much on “acidosis” creating pain syndromes in rheumatoid patients.
That's about all that comes to mind, right now. Do hope you both find answers for him soon so he can turn his progress for the better!
Peace, Maz
3 years is a long time. What is your brother's disease? He has seen no improvement? In the years that I have been monitoring this bulletin board I must say that is unusual. Is he on any supplements besides Minocycline? I wonder if some of those may be a poor companion for Minocycline. Is your brother on any other medicines? Have you considered a different antibiotic such as azithromycin?
So sorry to hear that your brother is not responding. Has he been taking an anti-inflammatory with the mino? Dr. Brown suggests that they are necessary at first; by reducing the inflammation surrounding the joints they give the antibiotics better access to those joints. If there is too much inflammation the antibiotics can't get to the joints and won't be as effective. For this reason, MTX may help the mino work better, but there are other anti-inflammatories that are safer, like celebrex and mobic, or if his stomach can tolerate them, naprosyn or motrin. Once the mino starts working, he can slowly wean off of the ant-inflammatories.
If he has already been taking anti-inflammatories, I would think it was time to try a different antibiotic. I don't know anything about healthcare in India, but if you had someone who knows how to administer the antibiotics thru an IV, it would be more effective as well. I hope you find something that works for him,
linda
Hello,
Thanks for all your inputs.
We do not have any doctor helping us and mostly are on our own with information gatered from this website/forum and books by Dr. Brown.
He is on NSAID, but has not tried other antibiotics.
He had his law exams in November and had taken Prednisone 2.5mg for about a fortnight. It helped him during that time.
He is on a diet which is meat/dairy free. He does have gluten in his food.
He has many job offers now that he has a law degree but in his present state he can not travel much and is in constant pain.
We were wondering if MTX can help him for the time being. He does want to continue with MINO in addition to that.
All rhmmys here suggest MTX and don't believe in MINO.
Please advice.
Regards
Mahesh BhagnariHi Mahesh,
It's probably salient just to mention that we are all patients here on this BB, so it's not possible for any of us to dispense medical advice, per say…only to offer possible suggestions as per our own personal experiences.
As such, hope you will understand that this can only be my personal opinion, as a fellow RA patient…and my humble opinion is but one opinion. Others here may have quite different views on the subject.
Methotrexate may alleviate your brother's symptoms for a while, but as if often the case with immunosuppressives, it's effects may begin to wear off and he may find he has to increase this dosage over time. My mother-in-law has psoriatic arthritis and has been on methotrexate for two years. It has already begun to wear off and her doctor has suggested she increase the dose. However, she is also in her late 70s, so she is not looking for “the cure”, just palliative comfort at this point.
As you've read, “The New Arthritis Breakthrough” you will understand that, in effect, methotrexate does have some deleterious side-effects and would essentially be countering the purpose of the antibiotics, as it acts as an immune suppressant. As a short term palliative, it may help. However, used in the long term at increasingly higher doses, methotrexate can be quite toxic to the liver and I've heard some reports of chemo-induced congestive heart failure in worst case scenarios. Not saying this to frighten you, but just mentioning long term possibilities. Methotrexate was designed originally as a cancer drug, but not intended for long term use as is often done with rheumatoid disease. If he is being observed by a doctor closely while using methotrexate, he may avoid these complications, but if they begin to occur, he would have to come off the drug and could end up being in a much worse condition or having to begin treatment with a different immunosuppressive drug.
As your brother is self-medicating on minocin, does this mean that Clindamycin IVs might also be a possibility for him? There is some good information on http://www.rheumatic.org under their FAQ section about what to do when progress is stalled. Clindy IVs might be just the thing to help jumpstart his progress. If Clindy IVs aren't available to him in India, is there any chance he could make it to see Dr S in Iowa? If travel is impossible, Dr S also takes phone consultations, I believe, so you could get his information by sending a brief email to:
Dr Brown wasn't averse to using prednisone in small doses for short periods of time to bring down inflammation and allow better penetrance of the antibiotic to the joints. Long term use of prednisone has it's own drawbacks, though, too.
Really the decision to try methotrexate has to be a personal one for your brother. I wouldn't want to dissuade anyone from trying something that may help in “the short term”. Some people do find that after a time they can actually reduce their methotrexate if they are taking it alongside mino, too, so it isn't all bad news. It's just one of those drugs that really needs to be watched carefully by a rheumatologist….and just to be fully aware of the longer term pitfalls. This is the type of question that could be discussed on a phone consult with Dr S.
Do hope your brother finds some relief soon, Mahesh. Please let us know how he's faring and what he decides. Perhaps others here will have different views to share that may help in his decision to give you a broader patient perspective.
Peace, Maz
hard to type just had surgery but wanted to say that i am on mtx, pred and mino. i believe the mino and pred have helped me more than the mtx, looking to stop it soon. if it were me i think i would increase my pred before going on mtx. 5 and under said to be safer and upping by just a little can make a dramatic difference…thanks for being such a caring brother.
good luck
sue
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