Mondays are my rest days from training and also my methotrexate days. I combine the two because methotrexate is the drug we love to hate in the autoimmune arthritis world. Its a great drug in that it helps control our disease but like any chemotherapy drug it has awful side effects.
Methotrexate (MTX) is an antifolate chemotherapy drug developed in 1947 for the treatment of acute lymphoblastic leukemia. The antifolate mechanism of the drug shuts down the fast replication of the cancer cells because they must have folate for the cells to synthesize their DNA. By inhibiting this replication the cancer cells cant continue to multiply at the fast rate they were and they die off. The problem with this is the chemotherapy affects other cells that replicate quickly by shutting down their DNA replication as well. This leads to hair loss, mouth ulcers and other nasty side effects. The drug is also hard on the liver since the liver metabolizes the drug and can cause damage to the liver over time. Despite the side effects and potential liver damage MTX is still used widely today for a number of cancers.
MTX low dose therapy was approved by the FDA in 1988 to treat rheumatoid arthritis, and then went on to treat many other autoimmune arthritis conditions. It is given either orally or by injection at home once a week. Dosage varies by the patient. Unlike cancer patients those with autoimmune disorders are allowed to take a folate supplement during the days of the week they are not taking methotrexate which inhibits some of the nasty side effects of hair loss, ulcers, etc. The methotrexate use in autoimmune disease inhibits the immune system from replicating itself causing the patient to be immune suppressed. The reason this is done is because autoimmune patients the immune system is attacking the person's own body.
Despite the fact that MTX is effective and as an arthritis patient I am given plenty of folate to take with it I like many patients get a lot of nasty symptoms on the drug. The most pleasant of which is nausea. Many Monday nights the stomach upset builds to a point where food is completely unappealing yet hunger makes the issue worse. My awesome husband bought me a magic bullet for when things are particularly awful so I can make milkshakes. For some odd reason milkshakes appeal to me when nothing else will. The advantage of making them at home is that I can shove spinach, fruit, and protein powder in making my milkshake somewhat less unhealthy tricking my body into getting some nutrients. I also get what is known as "brain fog" this means I am about as sharp as a box of rocks on Mondays. There is also a lot of fatigue with this drug and that certainly doesn't help mental acuity. I've also like a rocket scientist that has been hit on the head with a frying pan attempted to train on MTX days with disastrous results. This is why my MTX day was moved from Sunday to Monday. The MTX nausea is not your friend running, and you sweat like your a waterfall. This is why MTX day is my rest day.
Despite its awful side effect MTX is an awesome drug for autoimmune arthritics. It is generally well tolerated meaning the symptoms once a week are combated with excellent results in keeping the disease at bay. In my situation it combines with my TnF inhibitor Remicade making it more effective allowing me less inflammation, less pain, and preventing joint damage over time. Without MTX the remicade is less effective and my body is more likely to attack the remicade rendering it useless. I gladly trade one day a week of being sleepy and uninterested in food for the suppression of my disease and the pain it brings.
Currently I take a relatively high dose orally once a week, but shots reduce the symptoms. My tolerance hasn't improved with the start of remicade so my next appointment I am going to request injections. The injections often eliminate the nausea that accompanies the drug. We hope this helps me a little, since every little bit makes the journey easier.
Overall though I harp on how horrible MTX is it is a really wonderful drug. It has saved thousands of lives of cancer and autoimmune patients. It has certainly helped protect me from a lot of joint damage over the years. I am thankful that I can trade everyday with a lot of discomfort for one day of annoying icks. Without this drug I certainly would not be running today, and that in itself makes me very grateful that we have this option in our tool box against arthritis.
Captain Angry Bones
Hope the injectable works!
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