Dear Angela
Hair loss with Methotrexate was not mentioned out loud when Methotrexate was prescibed for me only in a leaflet. I experienced upsetting hair loss after six weeks and I was taking only two folic acid tablets per week. When I explained how I was feeling on 15mg and 2 Folic acid Tablets ie very tired as well and feeling all the time that I had bad cold, the folic acid was increased to 5 per week. Eventually the 5 made me feel a tiny bit better with the hair loss more managable. I hope that some-one will help you soon as I know this is a very upsetting side effect. Our bodies are very sensitive. I now take 6 folic Acid a week and do not feel so tired after taking the dreaded Methotrexate and my hair is behaving better now. This medication is very very stong but at least it is once a week. I have had R A for 3 years and had this medication for 2 and half years. I found this Medication seemed to be having a positive effect after about ten months.

Claire

You might find you need a higher dose of folic acid.

I lost a lot of hair on another drug called sulphasalazine. It finally all came back after I came off the drug, but it took a long time.

Hi Angela,

When you say 'my doctor' do you mean GP or Rheumy? If this is coming from your GP I would ask to see a rheumy to get their opinion. The problem is going to be that a dose low enough to avoid hair loss may be too small to have any therapeutic effect. There are plenty of other meds that can be tried. Have you tried anything else yet?

MTX is one of a group of drugs called DMARD (disease modifying anti rheumatic drugs) which also includes sulphasalazine and azathioprine. These medications have the merit of being cheap and in some cases very old drugs. That does not mean that they are not good treatments, I'm just making a statement of fact.

You may have seen mention of anti-TNF or biologic drugs on this forum. These are a fairly recent innovation and they come at a very high cost (£9000 a year is typical). That being the case the criteria under which they are offered to patients are strict and they include the fact that the patient must have tried and failed on two DMARD's.

What constitutes failure? Clearly, failure to treat the underlying symptoms would be one definition. Another is a set of side effects that are unacceptable to the patient. In other words, if you say no, that is 'failure.'

What I am actually saying is that any decision to use a lower dose of MTX is, effectively, yours; don't let yourself be pressured into a course of action that you are not happy with.

I had a very bad adverse reaction to MTX. That hasn't stopped it being mentioned a couple of times. My very firm no has been all that has been required to see those suggestions off.