Methotrexate and hydration

Hi everyone, my rheumy wants to put me on methotrexate injections to control my enteropathic arthritis. I'm currently on crutches now and can't walk on my left leg as it will cause my knee to blow up with fluid and pain. I'm also currently on Infliximab infusions every 8 weeks. 

Im concerned over several potential side effects from MTX but the one that I have red flagged is that MTX can make you dehydrated. I already have to drink heaps of fluid to remain hydrated due to my pouch and I just read this;

"In rare cases, this suppression of blood cell production can also occur at normal doses. This risk is higher in the elderly and in patients with reduced kidney function or dehydration."

Is this something to be concerned about or am I overreacting? 

Original Post

I take Methotrexate (12.5 mg or 5 pills once weekly) with Remicade and have not noticed any unusual dehydration. I have pretty good hydration hygiene generally and it has been a non issue. By the way you should take Folic Acid to counteract other possible side effects of Methotrexate. The most notable of which are cold sores in the mouth. I developed them when I didn’t take the Folic Acid a few days. If I take Folic Acid daily, there are no issues.

Thanks guys, ok i feel less nervous...but still slightly freakin out. Few more questions.

1. I'm 36yrs old, assuming MTX works for my arthritis and helps to prolong infliximab, would MTX be considered a long term solution or would i be weaned off it after 10 or so years to prevent liver damage?

2. How does MTX effect your pouch, does it help or cause issues?

3. Is it true that MTX kills your libido? Is there anything that can be done to counteract this side effect?

3. I have read about taking Folic acid daily, what about B12 shots is that common?

thanks again


Drone 3, responses to your bulleted questions:

1.  I have liver chemistries blood tests done monthly and if they see anything amiss they would switch me off, they will do same with you.  I have taken Methotrexate almost 2 years now.  NO effect.  Imuran sent my liver chemistries haywire, on the other hand, and I was taken right off it.

2.  MTX works with Remicade to keep it in your body, by suppressing renal secretions.  The only issues from it are mouth sores when I do not take Folic Acid.

3. Not true, my libido just depends on the woman I happen to be with at the moment. I spent Thanksgiving weekend in NYC with my current lady and there were like no issues at all taking care of business.  

4. Folic Acid taken every day does the job

Good luck



I have a couple of questions for you and your doctor. If you are chronically dehydrated and this puts you at a higher risk for the serious side effect of bone marrow suppression with MTX, why not consider azathioprine (Imuran) instead? 

Also, why injections over oral MTX? I presume it is due to the severity of your arthritis symptoms.

How about increasing your Remicade to 6 week intervals? This was the approach when my arthritic symptoms were not being covered well with 8 week intervals.


Ok, just got back from the rheumy. She has spoken to my Gastro. Dr and they want to switch me to Humira every 8 weeks and MTX injections every week, folic acid daily except for MTX injecting day.

The logic behind it is that Infliximab stopped working for my joints, but was keeping me out of hospital for bowel obstructions (I may have crohns, never proven through biopsy). My arthritis is very similar to Ankylosing Spondilitis and Humira will help both the spine, peripheral joints and GI inflammation. The MTX will also help the peripheral joints and prevent anti bodies being created against humira. I actually requested MTX injections to have less side effects. 

I wouldn't consider myself chronically dehydrated, I just drink a lot of water and i do wake up thirsty. The rheumy didn't think it would be an issue but told me to see how it goes and report back to her. Also, Gastro. Dr did suggest Imuran a while back but my rheumy said she doesn't like it, i'm not sure why.

I'm seeing my Gastro. Dr tomorrow as he is in charge of the biologics.  Is there any questions I should be asking him?

I'm slightly overwhelmed but the logic does make sense to me assuming both drugs help without major side effects.

thanks team

I think you are asking the right questions. My main advice is to be flexible and be open to changing/adjusting treatment as time goes on. I’ve been on biologics since 2005 and have gone through Enbrel, Humira, Simponi, Cimzia, and am now on Remicade. My main gripe with Humira is that it stings during injection. It hurts the least in the abdomen.


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