Sulfasalazine or Methotrexate?

[caroline]

These two drugs were presented to me as choices for treatment of seronegative arthritis (moderately severe since 12/07). I am on 100mg
minocin (3x week/2 a day) since early April which my doctor has now stepped up to daily/2 a day) for last two weeks, in hope of reducing
inflammation. Well, I still have inflammation.

Am leaning towards Sulfasalazine (enteric coating to prevent upset stomach) after hearing that a City of Hope doctor linked Methotrexate to triggering lymphoma. My Rheumatologist says there are no studies confirming this link but it makes me uneasy nevertheless & says that
Methotrexate is the “gold standard” but the choice is mine & I will have
to be on it for 6 months – year.

Alternative treatments/vegan diet did not signficantly reduce inflammation
as joint damage ensued.

Thanks for sharing your experience or opinion..
Caroline

[Goodwife]

There is a product made by metagenics called Ultrainflammx.  It is a powder that you mix with water or juice and take it (i think) once a day.    My hubby took this for about 6-8 months (combined w/antiinflammatory diet) and saw great results in his inflammation and also eventually his CRP came down to normal.  We saw a naturopathic doc which put him on this “treatment”.  Maybe it is worth a try talking wo a nat. doc.  Hubby also took various supplements, including omega 3, for inflammation.  Good luck

Goodwife

[Lizz]

Caroline, I have been taking sulfasalazine for two years, mino for 1 year, 4mg predisone for the last 4 months and, thanks to Goodwife, have been on Ultrainflaminix for 2 months. My last bloodwork shows my sed rate already down from 71 to 55 and anti-ccp down also. I think my mistake was not taking something immunosuppressive along with the mino for the first several months. The pred and Ultrainflaminix have made the difference. I soon as my labs return to normal, my hope is to wean off pred and eventually sulfasalazine. The sulfasalazine is a very benign drug compared to the methotrexate , which I have avoided taking. In his book, Dr. Brown is not adverse to 5mg or less of pred for a short period of time. I hope this info helps!

Lizz – RA 3 years, sulfasalazine 6/06, mino 5/07, pred 2/08, Ultrainflaminix 5/08

[Lizz]

Forgot to tell you I'm also seronegative.

[Sierra]

I've been on both. Methotrexate for 2 years, Sulfasalizine for less than a month. I tolerated MTX better (which is very unusual) but over time the side effects caught up with me. I'd recommend trying the sulfasalizine first as it's a safer drug and may agree with you just fine.

Sierra

[Rose]

Caroline,   Nine years ago they put me on Sulfasalazine four a day.  Then I discovered this site and Minocin and have been taking Minocin now five years in August.  Since then I have been able to cut my Sulfasalazine back.  Took two a day for a couple of years, and now to just one a day.  I do take the D-R taps which are coated because otherwise the non-coated ones  can play havoc with your stomach.   My last RF factor and Sed rate was good.  Rose

[lynnie_sydney]

Caroline – I was on sulfasalazine (enteric coated) for 2 years. Expect to wait 2-3 months for it to 'kick in' though. You will probably need additional help with inflammation during that time. After that, I found it very good at controlling my symptoms – was pretty symptom-free for 4-5 years all up. I now believe it was the antibiotic portion of the drug that worked.  I would take this over mthx any day in terms of long term side effects. If it were me, I'd also make some more enquiries about other possible dietary issues (leaky gut) and candida. You may need a more holistic practitioner to help with these aspects. Lynnie

Be well! Lynnie

Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)

[John McDonald]

Caroline,

Sulfasalazine, Plaquenil are said to be the most benign of the first line RA meds. Methotrexate isn't so benign. It seems to have harder side effects and it is said to be more immunosuppressive. It was when doc put me on methotrexate that I got spooked, looked about and blundered onto the Road Back. Before that I was just on Plaquenil. I didn't tolerate Sulfasalizine at all. It made every meal a nauseas ordeal. Doc's response to that is that some of his patients would consider that to be an acceptable trade-off. That statement was one of my first clues to (a) how serious my disease is and (b) how clueless that moron doc was. Such bedside manner!

When doc prescribed the MTX I asked him how immunosuppressive it was. I was about to fly to Asia while the SARS epidemic was still underway. He decided to have me wait on the MTX until I returned. That was unnerving. I was hoping he would tell me that it wouldn't affect my chances of contracting a brand new dread disease.

Sero negative or sero positive doesn't matter a lick. Either way you have RA and it hurts like hell. Either way they offer the same meds in the same order. They don't even know what the rheumatoid factor antibody is or why it is.  Check this casual search pagefor some real insight about how well medicine understands RH factor.

If I had it to do over again and I were in your place I would start with the MP. If I wasn't prepared for that and if I could stand it I would take Celebrex and Minocycline and avoid the other meds for a while, and I would (and did) avoid D as at least a superstitious nod to the MP. If my discomfort was too great and I had to choose between MTX and sulfasalazine I would choose the sulfasalazine. Or I would ask doc for Plaquenil instead. But either of those does take a couple of months to kick in.

AP works. It takes around a year unless you are lucky.

john

[KAnderson]

I have RA and am on Meth and Sulphasalasine in addition to Plaquenil.

I have had to come of Sulph due to some side effects, which included burning in my calf muscles walking a short distance on flat ground. Ive been off it for 5 days now and the pain is much less. Weird. Its also a bit unnerving the colour Sulph turns your wee! 😯

K

[GlitterGirl]

Hi there,

    I would definately go with John, the plaquinal, of the lot, is alot less aggravating, and has less side effects,  you have to have yours eyes tested, on the plaq, and I also found the generic plaq, to be not as effective as the brand, I did not tolerate the generic plaq well at all, it gave me headaches, and I had alot of problems with my eyes when on it, serious problems.  The Methotrexate, well, It does work, but the side effects are diabolic, to say the least, and I had allergic reactions to the sulfar!  I am a newbie on the AP, but not on the conventional meds.  The Methatrexate, along with deystoying your bone marrow, will in some people cause acute sinus infections, all the time, ear infections, pleural infections, and if it goes toxic it will also cause sores, and very painful nodules to form.  It's no fun at all.  Wishing you the very best of luck to you, take care, you have definately come to the right place for honesty and information, this site is a bounty of hope, positive affirmations, and wonderful information.  Take care.

GlitterGirl

[Author]

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