How long should mtx take to work, especially on scleritis (eye inflamation?)How long should mtx take to work, especially on scleritis (eye inflamation?)

I'm on Enbrel, sulfasalazine, prednisone, and have recently added mtx to try to get my eye under control. It has been red and inflamed for 3 months. After 3 weeks of mtx my dose went up to 20 mg, and after 4 weeks total I have seen no improvement. I'm worried it is not going to work at all, and not sure what the next step would be.

Answers from our Doctors

Dr. Ted Mikuls says:

Unfortunately, there is very little trial data examining the use of methotrexate (or other medicines for that matter) in the treatment of scleritis complicating rheumatoid arthritis. In the treatment of rheumatoid arthritis per se, methotrexate frequently takes several weeks to months to show a significant clinical benefit. In my own clinic, I generally use optimal weekly doses of methotrexate (20 to 25 mg per week) for periods of 3-4 months before making firm decisions about effectiveness or failure. Should the addition of methotrexate eventually fail to control these symptoms or should these symptoms progress in the meantime, other immunomodulating drugs have been used with some success in certain cases and could be considered by your rheumatologist in consultation with your ophthalmologist.

Answered on: Monday, May 10, 2010 - 12:23


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