Must You Have PA to use Methotrexate?
from Sara S.

Hello Ed:  My name is Sara and I live in Ireland. My mother in law suffers badly with psoriasis since she had a hysterectomy for cancer around 4-5 years ago. We spent time with them over the Christmas holidays and I have only just realized how much it affects her life and how sore it really is.

Recently someone else I know has told me that they have the condition in their nails and joints and have been prescribed with a drug that has cleared their skin also.

I think it’s called MTX or something similar. Is there any reason why my mother in law could not take this? She doesn’t have it in her joints.

I worry that all she is being prescribed is steroid creams that aren’t any good and that she’ll end up transparent one of these days!

Ireland, even though we are now in the 21^st Century, has only got two centers for light treatment and she lives in the middle between the two of them. That means she’d have a round trip of 300 miles if she was to subscribe to that.

I know you probably have LOADS of emails to answer but even a brief word or two would be greatly appreciated. I’ve printed out correspondence from your site for her because she has a great sense of humor and I know she’ll appreciate seeing the lighter side.

Hope this mail finds you well Ed, and that you enjoyed the holidays.  Regards,  -Sara S.

*****

Ed’s Response:  Methotrexate — MTX — is a powerful immune response suppressant usually prescribed for psoriatic arthritis (PA).  While it is known to help skin psoriasis in a percent of the psoriatic arthritics that take it, its effect on skin psoriasis aren’t as profound as they are on the arthritis.  For this reason most derms will recommend anything else for skin P before they prescribe MTX.  

A similar drug, cyclosporine, is much better known for its ability to clear skin lesions.

I’ve used both.  While I did experience improvement in my lesions with MTX, I was never entirely cleared.  On cyclosporine, however, I was entirely cleared, and remained so for several months until increasing blood pressure (one of the side effects of the drug) forced me to discontinue using it.

There are a number of health and lifestyle issues associated with taking either of these drugs and your mother-in-law’s doctor may have ruled out either or both of them because of contraindications in her case.  In any case, if your mother-in-law is uninformed about them, do encourage her to ask her doctor.  If the choices exist for her, she should by all means be allowed to make them.  -Ed

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