Methrotrexate and arthritic psoriasis

Posted Tue 19 Mar 2019 11.42am by Nickir

I was diagnosed with arthritic psoriasis by a rheumatologist 12 mths ago. Last October my psoriasis flared up very badly ( the loss of my father brought it on I think ). I was referred to a dermatologist who is looking to prescribe a drug called Methotrexate.

I believe this is a very very low form of chemotherapy which suppresses your immune system. He has told me it is very successful in treating both my arthritis and psoriasis.

However reading up on it there can be a few side effects and you can be prone to illness as the immune system is low.

Has anyone had any experience of this drug.... good and bad please.

I have my follow up appointment with the dermatologist on Friday 22nd March and am expecting him to be writing the prescription.

thanks in advance


Posted Tue 19 Mar 2019 11.54am by mazza

Hello there

Hope you don't mind me poking my nose in.

Sadly this isn't an answer to your question but, like yourself I am due to go on it myself early next month.

I too have read comments online and some of those were quite scary.

Hopefully someone can put both of our minds at rest in one go.

Good luck for the future.



Posted Tue 19 Mar 2019 12.17pm by Nickir (edited Tue 19 Mar 2019 12.17pm by Nickir)

Hi Mazza, absolutely not. we can both hopefully get some answers from people who may have had the drug. Like you I was rather scared of some of the comments. However I am airing towards the tablet as both my arthritis and psoriasis is at its worst and I need to try something completely different. I am on a waiting list for a long term steroid in my back but am told its still 6 mths away.

lets hope we get some good feedback and good luck too.

Posted Tue 19 Mar 2019 12.59pm by Suzie
I have suffered for around 7 years and have it covering my back and front.

Hi, I've been on MXT for about 5 years now and i'm lucky not to have experienced any side affects although i know there are people that have. Its worth a try though, if it doesn't work for you then you can stop.

Good luck to both of you.x

Posted Tue 19 Mar 2019 1.14pm by mazza

Thanks Suzie

Has the drug cleared it up completely. I shan't be to graphic about where I have it but, lets just say some days I walk like John Wayne !!!


Posted Tue 19 Mar 2019 1.27pm by Suzie
I have suffered for around 7 years and have it covering my back and front.

Hi Mazza, haha the wonderful places it turns up eh! So my Derm first put me on cyclosporine first as a quick fix which cleared it up within weeks then i changed to MXT after about 6 months and it stayed clear. I do get the odd bit on my scalp and around my ears from time to time but apart from that it works well for me. I'm not sure how long it will take to clear as i was on the cyclosporine first so maybe someone else will be able to answer that. x

Posted Tue 19 Mar 2019 1.28pm by mazza

Thanks Suzie.

Best wishes.

Posted Tue 19 Mar 2019 2.19pm by Johnboy_66

Hi all I'm new to methotrexate myself but to the person who is thinking about tablets I was on them for a couple of weeks and had a few of the nasty side effects I'm now on the pen injections had two doses and no real side effects to mention so I think that I will stay on injections hope this is helpfull to some of you.

Posted Tue 19 Mar 2019 5.14pm by Waffs

Hi Nicki, I have been on Methotrexate tablets for 20 months. I take 15mg once a week and 5mg of Folic acid tablets three times a week. For me, the methotrexate has worked wonders as I am virtually free of the psoriasis that has plagued me for 30 years. I too had it in my groin, my scalp, legs and feet as well as on my back. and I had a major flare up two years ago which was so bad that I was having to crawl every where as my hands and feet were covered in plagues that were extremely painful. I also have psoriatic arthritis and the methotrexate has helped with that but I still get pain all over the place. For me it helped and the folic acid helped with the side effects. I hope this eases your mind a bit. Good luck for the future whatever you decide.

Posted Wed 20 Mar 2019 11.53am by Nickir

thank you all for your feedback. looking forward to my consultant meeting on Friday to move this on further.


Posted Mon 25 Mar 2019 8.45am by Gravy9499

I have been on methotrexate for many years for my skin it took a short while to find the right dose that worked for me the only way I did not get any side effects was to increase my fitness level by doing that I've had no side effects for over a year I think it's very important to change your diet and your health and the way that you live for not only give your psoriasis a better chance but also to give your body a better chance accepting the drug the drug is a very strong drug they should be taken with caution but it's also very effective drug treating psoriasis hope this helps you all the best with your skin

Posted Tue 26 Mar 2019 0.56am by Tahoedude (edited Tue 26 Mar 2019 0.58am by Tahoedude)

Hi Nickir, I had pretty severe psoriasis that was on my elbows, ankles and thighs. After treatments with narrow band lights to keep it under control I decided to see a dermatologist recommended by a friend. The dermatologist put me on Methotrexate (six pills a week) and followed up in 45 days. When I returned to see the dermatologist she said we could do better and upped the dose to seven pills a week. She checked my blood work and said I was handling the medication well. The psoriasis cleared up well and had no issues. I was a little concerned as this drug does lower the ability of your immune system to fight infections. After about five months of usage, I developed a dry cough that would not go away, especially at night. I had to go off the medication and my psoriasis came back.

Upon returning to my dermatologist, she then put me on Acitretin, another psoriasis medication. This was the last oral medication I could take before going on injections. My medical insurance is not great and injections are very expensive. She recommended I take two pills per day which I began with one pill as the side effects are dry skin, chapped lips, weak nails dry nails, and overall dryness in the nose. Additionally, the pills are fairly expensive. Initially I had no luck with the psoriasis and my big toe toenail split causing an ingrown toenail. I lived with it for about a month as I thought it may heal itself, but it did not. The toe area became very red and infected and then my psoriasis got very bad (I believe the psoriasis flared up as my body was reacting to the infection). I decided to have the ingrown nail addressed and upped the medication to two pills. The toe healed and the medication is making my skin very dry with chapped lips and a very itchy back. After two weeks I am seeing improvement with the psoriasis but I'm not too crazy about the itchiness. I will keep you posted. From what I've read and heard, Acitretin is a safer medication to take than Methotrexate as it doesn't lower your immune system for infections. I am just trying to adjust to the dryness. I'll keep you posted.

Posted Thu 28 Mar 2019 6.06pm by Gazza

Ok, so I have been taking Methotrexate for 20 years or so.

I currently am on 7 x 2.5mg tablets per week and 1 Folic Acid tablet a week. I have a blood test every 2 months. I also use Alphosyl 2in1 Shampoo regularly. The psoriatric arthritis seems ok but matters are slightly complicated because I also have rheumatoid arthritis. Not that this a big deal as I use 10% Ibruprofen concentrate on those joints as and when necessary.

Insofar as Methotrexate is concerned have to say the skin cleared up after I increased from 6 to 7 tablets a week, so being clever I stopped taking them. After a while it returned and I went back on them. The situation now is that the patches have stabilised but do not bother me to the extent that I want to increase the dose. The Alphosyl 2in1 shampoo works well (I have tried others over the years) but I am now looking to try perhaps a coal tar emollient in my bath just to try to get the patches on the skin to disappear.

Not sure all this is very helpful but as a long term Methotrexate user the drug has not bothered me too much. Perhaps I am just lucky.

Posted Sun 7 Apr 2019 12.29pm by Headshoulderskneesandtoes

I am surprised that a dermatologist is prescribing methotrexate and diagnosing psa. It was my thinking that it is a rheumatologist who diagnoses psa and prescribes methotrexate etc.. that is what my dermatologist told me 2nd April 2019 and has reiterated to my gp the need for me to see a rheumatologist. Please can the people who are replying to this confirm dermatologist is diagnosing psa and prescribing methotrexate and if possible where about in the U.K. they are doesn’t need to be full postcode etc.. I am in Worcestershire area for treatment.

Posted Mon 8 Apr 2019 2.42pm by Nickir

Hi there as per my original thread it was my rheumatologist who diagnosed psa not my dermatologist. As I am seeing both consultants on a regular basis both are aware of each others options. I have done quite a bit of research and more often than not its the dermatologist who prescribes methotrexate and appears so in the threads of this message .

I would question that either could prescribe due to the nature of the drug and how works.

I am in the Warwickshire area.

good luck

Posted Mon 8 Apr 2019 3.46pm by Headshoulderskneesandtoes

It is probably that a gp or dermatologist can prescribe after a rheumatologist has diagnosed and first prescribed.

It wasn’t your post as it is clear your rheumatologist first diagnosed and prescribed,

it was other commenters who said there dermatologist had done so and I just wanted confirmed in what order.

I went to another gp today 6 days after my dermatologist and he wasn’t happy about the length of time I am waiting for a rheumatologist and said he couldn’t prescribe methotrexate but would if he could. He gave me naproxen.

Posted Mon 8 Apr 2019 4.28pm by Headshoulderskneesandtoes (edited Mon 8 Apr 2019 4.28pm by Headshoulderskneesandtoes)

Ok think I have worked it out using google. Dermatologist will/can prescribe methotrexate if psoriasis is really bad and not responding to creams lotions etc...

My dermatologist and gp was reluctant because I have not had my psa diagnosis by a rheumatologist yet.

Posted Mon 8 Apr 2019 4.33pm by Suzie
I have suffered for around 7 years and have it covering my back and front.

My dermatologist prescribed my methotrexate, I’m in Kent x

Posted Mon 8 Apr 2019 4.49pm by Headshoulderskneesandtoes

I have it on my scalp,chest,groin,legs,fingernails, toenails.

Posted Wed 10 Apr 2019 5.44pm by WorkingMumOf3

Hi, I’ve had PSA for 2 years and Nail Psoriasis for over 30 years. My rheumatologist prescribed Methotrexate for PSA in my hands. I had the usual nausea for 24 hours after taking it. But at week 4 I noticed my hair was falling out. I persevered until week 7 when I couldn’t cope with it anymore as my hairline was rapidly receding and my whole head of hair was thinning. It stopped falling out within a couple of weeks of stopping the treatment and started to grow back after a couple of months although my hair is not as thick or full anymore 18 months later. Also, what grew back was white, I am 47 years old so have aged prematurely,. Three months after stopping it, I had a huge flare which lasted 4 months. I’ve since tried sulphasalazine and apremilast to no avail. PSa has now spread to my feet. Rheumatologist wants me to try Leflunomide now but as it too is linked to hair loss, I have asked for an alternative. Methotrexate works for many people, but not for me. Good luck in whatever you decide.

Posted Thu 11 Apr 2019 5.19pm by Emmarie01

I was on Methotrexate for 3 years, but given my age I was one of the youngest people to use it (I was 12 or 13 at the time) and had quite a few of the side effects. I eventually stopped using it, despite my dermatologist telling me to do the opposite. I had to take 7 tablets each time and 3 folic acid tablets a week and after every dose, I was constantly sick, was pale and lost my appetite. The tablets worked wonders at first for my psoriasis but after a couple of months, it stopped having the same affect and my skin went back to how it used to be. As soon as I went off it, my sickness stopped and my psoriasis didn’t get any worse than it already was. I’m 17 now, and yes my skin is awful at the moment but I’d never go back onto Methotrexate

Posted Mon 20 May 2019 2.32pm by mazza

Well, this is my fifth week on Methotrexate. I too like so many others were reluctant to take this drug due to reported horrendous side effects.

I must be one of the lucky ones. So far so good. I did have some nausea along with loss of appetite but that was due to a vitamin deficiency.

Must say I haven't seen a great improvement in my psoriasis but it's early days.

So to others who are thinking twice, think again.


Posted Sun 2 Jun 2019 10.46pm by Becky0102
Hi im 22 years old, Ive had psoriasis since I can remember and recently been diagnosed with PA.

Hi, I was on methetraxate when I was diagnosed. Absolutely amazing! The pain and swelling went after a few months of taking the drug for me. And my psoriasis completely went also! However I took my tablets on Sundays but after a few weeks I couldn't stand the smell or taste of a roast dinner physically made me sick. Then I stopped eating completely and lost so much weight (I'm already thin as it is). I went onto the injection sadly this also did not help with my nausea and eating.

However this did not effect my immune system. I am a nurse so I'm in regular contact with infections and illnesses/bugs and I didn't catch anything or become Ill whilst on methetrexate.

I'm now on lefronamide which is a different story....

Posted Mon 3 Jun 2019 8.30am by WorkingMumOf3

Hi Becky0102, I am about to start leflunomide and would be very interested to hear what your experience of this drug is. As mentioned in my previous post on this thread, I suffered hair loss on MTX and am worried about the same in leflunomide?

Posted Thu 6 Jun 2019 3.49pm by Becky0102
Hi im 22 years old, Ive had psoriasis since I can remember and recently been diagnosed with PA.

I do still have hair loss with lefronamide. But a few weeks after I switched once the mtx went out my system my sickness vanished. I started eating properly again and stopped loosing weight. I'm glad I was switched over. Can't think of anything worse than mtx.

Posted Thu 6 Jun 2019 5.34pm by Headshoulderskneesandtoes

Just a quick update. After my dermatologist said no creams or lotions would cure or help my psoriasis in April and he thought I had psa I have been seen by a rheumatologist. Had x ray of chest and he wants start me on methotrexate end of June after he confirmed I have psa.

Posted Fri 5 Jul 2019 7.35am by JennyD

I’ve been on methotrexate for 10 years with no significant side effects. I’m on 20mg once per week gradually built up to the right dose over time. Nausea and headaches to begin with but taking folic acid everyday except the day if methotrexate sorts that. Keeps me reasonably clear of both arthritis and skin flare ups. Monitored by monthly blood tests as it can steer your liver. All ok so far. Adding in Vit D by the consultant about 5 years ago seemed to achieve the best results so I’m staying on it all for now and not rocking the boat. I don’t think I’ve had any extra infections/colds etc compared to anyone else. Seems to regulate my immune system rather than diminish it.

Posted Fri 5 Jul 2019 11.43am by ACC (edited Fri 5 Jul 2019 11.44am by ACC)

Hi there, just joined the forum so new to all of this. Not new to methotrexate however, been on it for 4 years (6 tabs per week). But I am just entering my fifth week off it. Following a fairly robust discussion between my liver specialist and dermatologist it was agreed that it was damaging my liver and must be stopped. The rebound flare up has been huge and as we sit is the worst it has ever been in 15 years, every where it has always been and now some it has never been before! The upside however is that I have just been approved for Biologics and if my bloods are ok then should begin within a week or 10 days.Fingers crossed!

Posted Tue 9 Jul 2019 7.54am by Nickir

Hi guys, thank you for all your comments, thought I would give an update to my progress. When I first posted the question asking about your experiences I was very nervous about taking methotrexate. I have been on it for 7 weeks, Just had my dosage increased to 5 pills a week. I do get the odd day where I feel a little sick but nothing other than that. Its early days however I have definitely seen a an improvement in my psoriasis and my arthritis, whilst Im still in pain is not at any stretch at the level when I started and my skin is improving. Am I convinced its the tablets or that I have had a complete overhaul of my life. I am exercising more by walking every evening and have totally changed my diet with the added bonus of loosing 16lb in 7 weeks. this would definitely have an affect.

Last week I also started Benepali injections so am hoping these will also slow down the onset of anymore arthritis.

still having regular blood tests and all good there.

I am a great believer if you don't try how do you know so with my positive head on its all good so far.

good luck to everyone.


Posted Tue 9 Jul 2019 11.03am by Penorri

Hi All,

I have suffered with psoriasis for 20 years and it started with a patch alongside an operation scar on my back. I was involved in a motorcycle accident and had damage to my spine. After the major surgery, the psoriasis started and the docs seem to think that a traumatic episode was the cause. I have had all the different ointments and light treatment but it kept coming back. Then it crept into my joints and I was prescribed Sulpasalazine by a rheumatology consultant. On it for 3 months and then became ill. It had wiped out my white blood cells so was immediately stopped. I was then prescribed methotrexate. Was on that for 3 months and then suddenly found that I couldnt breathe properly. Was rushed into hospital and diagnosed with pneumonitis which is an inflammation of the lining of the lungs. I was in hospital for 2 weeks on oxygen , steroids and very high dose antibiotics. Needless to say, methotrexate was stopped, although while on it my psoriasis nearly disappeared. It has now flared up badly and it is now over most of my body, which I have never had. Sorry to scare you all but if you are put on these drugs, make sure your consultants regularly check your blood counts. Apparently methotrexate can cause pneumonitis but nobody told me that when they started it and they dam well knew about it.

These drugs are toxic, only accept them if all else has failed. They now want to prescribe me Apremilast and to be honest I,m scared to take any drugs for this condition.

Best of luck all.

Posted Wed 10 Jul 2019 6.44am by OhNo_NotAgain?

Penorri: I obviously cannot comment directly on your experiences, but I do know several people on methotrexate in different parts of the UK. They were all warned about potential side effets and the need for regular blood tests - which they have all had. Some had to come off the treatment quite quickly, some did not. I am actually surprised to hear that anyone was not given the same warnings and follow-up.

Posted Tue 20 Aug 2019 5.21pm by Ginner

Hello to you all, I'm new to the forum. I've had psoriasis for 20 years and have just been diagnosed with psa.

I've just been prescribed 15mg of MTX plus folic acid 3 times a week which I started today so fingers crossed I have no side effects with it but will update with any changes and progress going forward which may be helpfull for people thinking of starting methotrexate.

Good luck and best wishes to you all.

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