Heather: 

When you read about the side effects of methotrexate it is important to realize a few things.  Firstly, they are a list of "potential side effects".  The vast majority of patients taking MTX never get any of them.  Also, many of them listed are done so because they are seen mostly when high doses of MTX are used in patients (for example to treat cancer) rather than the low doses used to treat RA.  The most common side effects are mild and reversible with using lower doses if and when the do occur.  MTX is considered the gold standard and first drug of choice for treating RA because after its being used for 30 years now by rheumatologists, it comes out way ahead of the pack as far as safety combined with its effectiveness for many patients. 

In addition, you have to compare the disease to the treatment.  While the vast majority of patients taking methotrexate will not get any side effects from the MTX;  RA itself can be devastating across the board causing the pain, stiffness, difficulty with doing one's daily activities.  Over time, it is a crippling disease.  Not only that, it is a deadly disease.  Patients with RA die about 10 years younger than their peers because of the systemic inflammation causing early onset cardiovascular disease.  Recent studies suggest that patients being treated aggressively to get their disease under control are most likely having less problems with these complications of RA (to include heart disease).  When I did my rheumatology fellowship in the early 90s, I remember our waiting room full of folks in wheel chairs and crippled up.  These days, it is markedly less so, in fact, the orthopedists tell us they are not doing nearly as many surgeries on RA patients as they used to because of the much better treatment these days.

It is just very important to make sure that you do get your blood tests done every 4-12 weeks on the medicine (to make sure your liver enzymes and blood counts stay OK), that you drink very limited alcohol if any, and that if you do get any side effects (like diarrhea, stomach upset, rash, hair loss,etc.) that you let your doctor know.  Also, your doctor should also have you on either folic acid or leucovorin to prevent side effects, so make sure you are also taking one of them.  These days with so many really good medicines available, a large percentage of patients are able to get under control and be in "remission" on medications.  If MTX doesn't do so, your doctor may talk to you about adding one of the biologics to your regimen.

Best wishes!

I am sorry that you are suffering. I too have RA and the mornings are the WORST! Do you exercise at all? Even though it is very hard, I try to move as much as possible. It seems to help somewhat. I have the DS so I am not much help on the drug front. I hope that you find the answers that you need.

I have read many posts about R.A. after gastric bypass.   I never thought it would have anything to do with my RNY.  My rheumatologist put me on methotrexate pills and after 12 weeks she took me off because I was getting worse.  She wants me to start methotrexate injections in 2 weeks.  I am allergic to sulfa drugs so she said I can't take anything else.  I worry about the bad side effects of methotrexate.  Anyone have any other ideas?  I am tired of being in pain all the time.  The mornings are worst, but now it is attacking my back.  Thanks for all your help.

 I am a little scared of the pain medications.  I know it is better to be pain free, but not at the cost of an addiction. If you can, let me know if and when you get back to therapy how it goes. But I think that is the major concern.   

Wishing you all the best in your search for a surgeon.  I didn't have my wls at bayshore but have lived in the pasadena area for most of my life and I will say that I wouldn't go to bayshore unless I was going to die before getting somewhere else.  This hospital is known for making mistakes and not being a great place.  Most people you talk to in this area will tell you to stay away from there.  I am sure there are other HCA hospitals around.  Hope this helps you.  I am sorry to be negative about this hospital just want to be honest.