Help with Mino and Methotrexate

[Anonymous]

Hello,

Last fall my wife was diagnosed with Mixed Connective Tissue Disease at 36. Once we found out what that actually was we set out to learn as much as we could which is how we found TRBF.

My wifes Rheumy did not support her getting on AP, so we found a DO a couple of hours away who has experience.

She has been on a low dose of Methotrexate (5 pills once a week) since December and began pulse dosing Mino 100mg twice a day on MWF on March 1st.

As of right now the Rheumy does not know that she is on AP therapy, but she intends to tell him at her next visit and the DO is going to send him a letter in the next couple of weeks letting him know she is treating her with AP therapy. The DO requires that we keep a Rheumy and wants her to stay on his treatment for the balance of this year so the AP has time to work.

About a week ago she began having a flair in her hands and feet which has been the worst she's ever experienced. After a conversation yesterday with the Rheumy he said he may bump her to the next level of the Methotrexate at her next appoinment. She is also just getting over a 2 month fight with Mono, which is the second time she's had it in 3 years, so I don't know if that has anything to do with it either.

Does anyone know if there any negative interactions we should be looking for between the Methotrexate and Minocin?

I am a little concerned that this recent flair up could somehow be related to her taking the two medications.

We're still pretty overwhelmed by all of this, if anyone has any other thoughts, suggestions or positive reinforcement we'd sure love to her it.

Thanks!

[John McDonald]

Methotrexate was developed to inhibit folate synthesis to treat cancer. The idea is to throw a wrench in the works of DNA and RNA synthesis, and also by consequence protein synthesis in rapidly dividing cancer cells.  Wikipedia says this about Methotrexate and RA:

Lower doses of methotrexate have been shown to be very effective for the management of rheumatoid arthritis and psoriasis. In these cases inhibition of dihydrofolate reductase (DHFR) is not thought to be the main mechanism, rather the inhibition of enzymes involved in purine metabolism, leading to accumulation of adenosine, or the inhibition of T cell activation and suppression of intercellular adhesion molecule expression by T cells.[2][/suP]

I think that means they don't know how it works on RA, except as an immuno-suppresant. I think if I were in your shoes, if I had to take a traditional DMARD alongside the antibiotic then I would ask my rheumatologist to substitute Plaquenil in place of the methotrexate. I think Plaquenil is much less immuno-suppressive.  But you are in a pickle between these two docs. I suspect your rheumy won't much like the DO treating the same disease with another med, any other med. I am surprised that your DO even agreed to do so.

I have seen other people take both mtx and Minocycline together with the goal to get off of the mtx as soon as possible. I myself took Plaquenil and Minocycline together as my own compromise with my doc until the Minocycline kicked in. Then I stopped the Plaquenil. If you think you are treating a microbial infection as Dr. Brown thought then I would argue that the methotrexate and Minocycline are working somewhat at cross purposes, immune suppression vs. microbial destruction.  If you believe as one or both of your docs do that you are treating a runaway, self-destructive immune response then there is not conflict between the mtx and minocycline, except that the mtx has much nastier side effects.

Your wife's flare could be flare, or it could be a herx response from the minocyclie; no way to know yet.  I wish I could offer more.  During the first few months of AP it can be tough to figure out what is happening.

 

[steph-sclero]

Hi PITAgator;

First off, Kudos's to you for taking an active role in your wife's diagnosis. Your support will be invaluable in the coming months and years ahead. It is also hard on her bad days to feel like researching anything, keep up the very useful research. It is going to be overwhelming for a while, first the realization of her diagnosis and then all the info. that will be thrown at you. Absorb what you can little by little or you'll become discouraged by it's immensity. It may seem like there is this urgency to it all but there isn't really. You have already cut through what took some of us years by getting your wife on AP and finding a doc to support you in that. Some people on this board are still very much alone; just their own research and a kind GP. In short all of this will just become apart of your life like anything else someday. AP doesn't work overnight but it does work, hold onto that fact through it all. Tell your wife, quite truly, everything is going to be okay. Know how powerful your roll as her advocate is and stay strong for her. Take care!

Best of Luck,

Steph

[Denyse]

I myself have been on Methotrexate 8 pills a week with Mino and had some noticeable joint swelling, so switched to Doxcy (vibra-tabs)with the MTHX and have been fine for over year.

 

 

 

 

_____________________________
Denyse/SD Since May 06

Mino/ Doxcy 50mg  MWD since Jan 07

CANADIAN LIVING IN CANADA
Diagnosis/ Diffuse Scleroderma since 05/2006
Current Meds: Methotrexate, Minocin, Zantac, Rabeprozale, Zopiclone
Current Supp: Nattokinase, Serrapeptase, COQ10, Milk Thistle, Folate,, B12, D3, Melissa, UP4 probiotics, N-A-C
medical MJ
Current Extras: FIR

[Loria Chaddon]

My husband also has Mixed Connective Tissue Disease and is presently on Mtx and pulse dosing Mino (along with a host of other meds and supplements :doh:).  I do know that I have read in one of the articles from a Rheumatology journal that there is some evidence the Mtx works best when partnered with Mino.  Unfortunately I cannot remember which article it was. (The amount of literature I have read from all sides of treatment on these diseases is staggering, as I am sure it is for others out there)

We will probably stick with the combo until the AP has had time to kick in.

I have heard that Plaquinel is an effective medication and both our Internal Medicine doc and the Rheumy we saw in Anchorage suggested it along with the Mtx.  My husband will not take it because it can damage the eyes.  He is an artist and has decided that, even if he loses everything else, the one thing he does not want to lose is his eyes.

I too am taking an active role in my significant other's treatments, so I know where you are coming from.  It is not an easy road for any of us.  We draw strength from each other, and I hope that you and your wife will be able to as well.  I truly hope that your wife's MCTD does not develop the number of complications my husband's has.  It is like a hydra, with more heads popping up everytime a new test is run.  Good luck, and remember to enjoy the little things, and make the most of those times when she feels reasonably good.  Stay strong.

[Anonymous]

Thanks for all of the positive comments, information and support.

This most recent flair is continuing to be the worst yet and my wife called to move her appointment with the Rheumy up, she is seeing him tomorrow.

After a lot of discussion we have decided to make the trip to see Dr. Sinnott. It's only about a 14 hour drive and we are both fortunate enough to be able to work from the otel room, so we'll only need to use a couple of vacation days.

Our appointment is set for June 10th, and we're both very excited. We could have had an appointment sooner but needed some time to coordinate everything.

We're both concerned that she is not reacting to the med's from the Rheumy and continuing to go down hill. IV therapy seems like just what she need to give the pills a head start.

Loria, my wife was on Plaquenil for 3 months and it did nothing to help her. I do appreciate the insight on what you husband is taking as they sound very similar. I am just concerned about him upping the dose of MTX, she's currently on 6 – 2.5mg tablets once a week which I know is fairly low.

Denyse, how are you reacting to the Methotrexate? (since switching to Doxy) You take 2 more pills a week than my wife.

[Fredam]

I have been on methotrexate  (6 tablets weekly) for 5 years and started on minicin in January, 2007.  I now take azithromycin in place of the minicin.  I absolutely did not have any reaction from the combination of metho and minicin.

FredaM

[Loria Chaddon]

PITAgater,

We will be there the same week.  Our appointment is on June 9.  Maybe we will get a chance to say hi.  🙂  We will be staying at the Super 8.  I already have reservations.

Our trip is a bit longer than yours.  We will be flying from Fairbanks, Alaska to Denver, CO then renting a car and driving the rest of the way.  (May seem odd to fly in to a location so far away from our destination, but I am trying to balance our ticket cost with airline miles, so that we can manage the trip.)   It should be a pretty drive.

Have you been keeping up with the thread where JBJBJB is telling about her time down there right now?  I will have to bring my laptop and do the same.

Good luck and I hope you guys have a safe trip.

Loria

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