In this video, we’re going to look at one user’s experience of shifting from tablet methotrexate to injectable methotrexate, and what their experience was like to see whether it’s something you might want to consider with your rheumatologist.

Hi, I’m Clint Paddison, and I help people with rheumatoid arthritis and other inflammatory arthritic conditions to make great decisions, science-based decisions to have the best possible life with inflammatory arthritis.

Today, we’re talking about methotrexate. A very, very common drug and something that I was on for three and a half years and I was on the tablet form. Now, today we’re going to look at the possibility of switching from tablet to injectable and whether or not that’s something you want to talk about with your rheumatologist. I am drawing upon the experience of a member from rheumatoid support, which is our coaching and community platform, and his name is Brad, and I will withhold all other information about Brad because this is a private platform and he’s talking to Finn, who I will also just refer to as Finn with no other information. And I have approval from Brad to go ahead and share his comment. The reason I’m doing this is because the information they have shared or they are discussing is very valuable. And whilst I share within the rheumatoid support platform, I also wanted to share it on the podcast so that we can all benefit from Brad’s fantastic user experience because it might be something that you want to consider.

So Finn is on tablet methotrexate, and she is describing in an earlier post above the one that you can see on my screen if you’re watching it on YouTube. She has been describing the nausea that she gets, and I experience this as well, I had terrible fatigue on tablet methotrexate. And so Brad comes in to explain his experience about how he shifted to the injectable form.

Now he says, nice to see your inflammation markers are still on the low side and no liver issues. And of course, why he says that is because with methotrexate, you can get elevated ALT and AST, which are enzymes coming from the liver, and if they get elevated, it can indicate liver damage. And if your liver is showing signs of damage, then the dosage of methotrexate may need to be adjusted downwards. And of course, this is all being overseen by your rheumatologist. I’m just giving you the broad sort of guidelines with this. So what Brad has said here is do not fear injections, I’ve been doing them for a year now. I was on 20 mg, which is eight times 2.5 mg tablets of methotrexate pills for over a year with lots of side effects. He had fatigue, as we’ve discussed, mouth sores, and nausea.

He’s a very active person, Brad, we’ve learned through the support forum here with these comments, he said, you know, I’m not one to sit down and take it easy. So I pushed myself hard and muddled through, but it was a struggle, I struggled Finn. My rheumatologist wanted to change meds to Arava, to (inaudible) every day, and the only reason I resisted taking Arriva and continued taking the methotrexate was because the methotrexate was working. My inflammation markers and my pain levels were down and the methotrexate was stopping further joint damage. So I requested we go to injections, as I heard on the PP or Paddison program, that it often helps to avoid the gut and can reduce symptoms of fatigue and nausea.

OK, so, of course, when we think about what’s happening, when we take the tablet that goes through the same process as your food, so it goes through the digestive system. Okay. And so this process of metabolizing the methotrexate via that path can contribute to the symptoms of fatigue and nausea. And it’s something that our guest rheumatologist talk about on our live monthly calls that comes up quite a lot. And so Brad has referenced that and has said, well, he talked to his rheumatologist about getting it injected because if you bypass the digestive system, then you may not get that nausea or fatigue. And then in bold, he has written here the injections worked Finn. After a couple of weeks, the fatigue and nausea after a couple of weeks were significantly less and the mouth sores are almost completely gone. I still had morning stiffness in my thumb, index, and middle fingers on my right hand were still very swollen. But the other really cool thing with the injections is they avoid the gut, I got better absorption of the meds and I was safely able to reduce the amount of drug I needed to use.

I think that’s key. OK, so the effectiveness is higher because of the absorption because it’s straight into the bloodstream. Keep in mind, I was working out rehabbing damaged ligaments, resistance training and doing lots of cardio workouts with clients in my gym class. Shortly after starting injections, I really dialed in the diet to the Paddison program, it was a slow process for me Fin. Within two months, the swelling in my thumb and index finger was gone. Within 10 months, that chronic middle finger swelling was finally gone as well.

Notice the time involved 10 months to get rid of that middle finger swelling okay which was chronic. All right. So there’s another lesson there that nothing happens really quick, this is slow, this is normal.

I still have morning stiffness in my right hand, but it’s mostly gone within a few minutes of getting up. He says we referring to him in the rheumatologist, we have reduced the methotrexate from 20 mg to 15 mg and I’ve been given the green light to reduce this a bit further. I’m also seriously considering shifting my training towards getting back into competition.

Rheumatoid Arthritis Support

So look at it, look at how effective this has been for Brad, it’s been sensational. So when he refers to getting back into competition, Brad’s very athletic. And this is obviously a tremendous progress and excitement for him, being able to consider being able to, you know, do athletic activities at a higher level. He says, telling you this to give you some hope Finn. It takes time and it requires we assault RA on all fronts. Diet, exercise, sleep, reducing stress, taking meds, and even in how we administer these meds all play a crucial role in our recovery. Be brave, be strong, you are young and vibrant. You got this Finn.

OK, so. That’s what I’m talking about, some fantastic encouragement and fantastic information being shared inside a supportive environment. This is why people in Rheumatoid Support improve. And you can see why I wanted to share this single post here by Brad to Finn in her journal and why I thought this was such a good one to share, because Brad really does cover all of the considerations here. And he has made this change with his rheumatologist, and he has had tremendous results. And it was specifically to overcome the nausea. And he also had the mouth sores and fatigue from the methotrexate. Now, not everyone will experience the fatigue from tablet methotrexate. And I know you might be listening to this, you might not even be taking methotrexate, but the vast majority of people have taken it or are taking it with inflammatory arthritis or have done so at some point. And so I thought this was a very widely useful post here.

So thanks for listening, I hope this is helpful, and have a discussion with your rheumatologist if this feels like it’s something for you. And if you’d like to come join us and be part of our supportive community, then you can upgrade from inside your membership within Paddison Program or Rheumatoid Solutions, it’s a simple one click upgrade or just email us And hope to see you and talk with you on a regular basis in the future. Have a sensational day.

Clint Paddison

Your email address will not be published. Required fields are marked

  1. Thanks Clint, I am definitely going to ask my doctor and Rheumi about doing the injections, as I suffer terribly from fatigue and have noticed nausea too lately. I have had RA since 2014 and have stuck to only 10 mg Metho as any more (25mg) makes me feel really ill and my liver went "deranged". My Rheumi put me on Arava (with the Metho) last Aug 2020 and that was a disaster and I ended up in hospital with severe diahorrea and on a drip for 3 days. The digestive gastro specialist who treated me in hospital had to give me an antidote drug (Questran) to get the Arava out of my system. My CRP went to 140 in hospital, but went back to CRP 3 going back to just 10mg Metho after the Questran cleared my the Arava away. Thanks for all your brilliant research and advice. Can you (or have you done already?) a Podcast on drinking wine whilst on Metho, as I still drink wine with meals and have tried to give it up with no success! I am hoping perhaps if I have the injections rather than the tablets that my gut will be happier. I never know whether it is the wine or the Metho that makes me feel sick in the mornings. I try to stick to your Paddison Program diet, and have green shakes in the morning, and avoid meat and dairy as much as possible, but I tend to lapse after a while. Rosemary

    1. Both alcohol and methotrexate can potentially damage the liver. I don’t drink alcohol now, and I didn’t on MTX

  2. Hi Clint:

    Unfortunately the Methrotexate in injectable form didn’t work for me. I was taking 8 tablets once a week and I was actually fine with the tablets, except I did notice a little bit of hair loss though. Then my Rheumatologist suggested the injectable form because she said it would be more effective so I tried it out just to find out that it gave me excruciating metal taste in my mouth and my hair loss got worst. I went back to the tablets but unfortunately by then I was still experiencing the same side effects so we had to switch to another medication. I ended up switching Rheumatologist all together and now my new doctor has me on Actemra 162 mg. This biologic isn’t working really well, the side effects are very mild but it isn’t really helping me with the inflammation and joint pain. I am now seeing a Naturopathic doctor in hopes to get much improvement and go into remission.

    I tried the Paddison Program in the past but I was losing so much weight I had to stop. I still listen to your Podcast they are very interesting and informative. Thank you for all you do!!

  3. Hi Clint. I have had RA for 20 yrs . I have been on almost every drug available, but the constant drug is now Methotrexate. My problem now is with Arthritic Nodules. Which I haven't heard you address. Last year my Rhemy sent me to a Dermatologist who put shots in my hands and feet. they're painful in the feet causing me to quit my walks and weight gain. as they were some form of a steroid. They quit growing for a while but now they have started growing again, soon I will have trouble putting on shoes again.. I really think that reducing the Methotrexate will help. I was on the pills for many years ,the pills started to make me nauseated 5yrs ago I started injections. I currently inject 0.6 millilitres once a week. Do you have any comments on Arthritic Nodules? Thanks so much for the work you do for RAsufferers I am shifting to a more plant based diet, feeling less inflamed . wold love to start the PP but financially not able to right now. thanks !

  4. Clint your Programme is a life changer!
    I switched to 10mg injectable Methotrexate 7years ago with only positive side effects.
    I have been RA symptom free since changing over and my inflammation markers stable.
    I see my Rheumatologist every six months,
    And continue to follow the Paddison Programme eating programme.

    I am fit and can do everything in life that I want to do and I am 70 years old this year!

{"email":"Email address invalid","url":"Website address invalid","required":"Required field missing"}