Haven't really read through the replies, but having used both prednisone and methotrexate and having the methotrexate damage my liver, I still want to say - GET OFF THE STEROIDS!!!

Basically, prednisone strips calcium from your bones making your risk for osteoporosis much, much greater. My rheumy was flipping out over me being on 20mg of prednisone daily and had me taking special calcium supplements. I tried to stay at 10mg or under, but I was on prednisone continuously for quite some years. I see the effect on my teeth - fillings falling out and crumbling because the tooth has been weakened - I think I'm going to be dealing with that side of things for a while. I'm also at a stage where I'll deal with being in agony and unable to move rather than take the prednisone because it makes me angry and aggressive. Last time I took it was actually for an allergy that had my eye swelled shut. I found myself in a rage where I wanted to throw my son into a wall. I reduced my dosage much faster than I was meant to (but because it was short term this time, that was ok) and I simply flat out WILL NOT take prednisone again.

Now... the methotrexate.

Yes, it's a scary drug. Yes, it's used in chemotherapy - and that's what a lot of the sites you would have been looking at were probably talking about. You'll be taking it at much lower doses than a chemo patient. It does lower the immune system, but that's the way it works - your immune system is going nuts and doing stuff it shouldn't and you can't suppress the immune system to stop that without stopping your immune system from doing stuff it should be - if that makes sense. The big thing I would suggest - lots of hand washing and have hand sanitiser pretty much everywhere. Be absolutely anal about sanitising before eating, before touching your face, before dealing with food. If your kids are in day care, do everything you can to build their immune systems. I keep Sam in day care and I have to rely on his immune system to protect me (I'm no longer on mtx, but I am still on immune suppressants - stronger ones now).

You will need to have regular blood tests to keep an eye on your liver function. I've heard stories of one doctor telling their patient "don't worry about blood tests, just one day you'll wake up and you'll have turned yellow and then you'll know to stop". Scary. Monthly blood tests and they'll pick up any issues long before you turn yellow and long before permanent damage is done to your liver.

You will also need to take folate supplements. Speak to any doctor about folate supplements with mtx and you'll get a different answer on the dosing regime from all of them. You will most likely want the 5mg megafol tablets. I started with the lower dose general ones (can't remember the dose there!) and I had terrible trouble with nausea and diarrhea for about 2-3 days after I took my mtx. Switched to the higher dose folate and that became more manageable. It is important that you start slowly (I started on 5mg the first week and we increased by 2.5mg each week until we got to 15mg, stopped for a bit, then went to 20mg), it helps you manage the side effects. I'd also suggest that you take the tablets at night as they would knock me around something shocking. In the early days (I started when Sam was 8 weeks old) I would fall asleep, sleep for 12 hours and not hear a thing... So DH was obviously dealing with Sam over night! But it was just that first night. I'd be sleepy and nauseated and generally out of it the following day, so again liked to have someone around on that day to help with Sam, and would avoid driving. After a while, I had none of these issues and my sleep after mtx was normal, I was still a little fuzzy on the day afterwards, but could cope. You may not be effected this badly, you may not be effected at all.

I must be lucky that I was through a rheumatologist - I get a blood test form every 6 months, and he has repeat blood tests on that for me. They are ALWAYS bulk billed. If the dermatologist-ordered blood tests are going to be super-expensive, get your GP to order them and copy your specialist in on the results. My specialist copies my GP in so he has huge files of blood test results, but that's helpful - I have everything to take to a gastroenterologist tomorrow.

My liver issues aren't uncommon, but there's no guarantee that it will happen to you as well. We know my problems were caused by the mtx (my liver started to get upset at 17.5mg, so we took a break but then had to push the dose to 20mg in order for me to qualify for a different line of drugs), but I was on at least two other liver-toxic drugs at the time. The liver issues have continued as well, so it's certainly a bit more complicated than "mtx trashed my liver" for me.

The final thing - you absolutely MUST have some form of reliable contraception. They prefer the OCP, implanon, mirena, etc. Something hormonal, they trust it more, it seems. Methotrexate causes horrendous birth defects (and miscarriages) so they insist on good contraception, and if you do wish to have another baby, minimum of 3, preferably 6 months off mtx and continuing the high dose folate tablets through this time before you even start to TTC.

If there's anything I've missed, feel free to ask. I know I have a different condition, and in the end it wasn't controlled by mtx, but it did work initially and it worked WELL.

BW