I recently read that methotrexate might be more effective at lower doses, if injected weekly, rather than taking it orally. Also, I heard methotrexate may have a negative effect on bone-density.
I would like to get completely off prednisone, and I am wondering if injecting methotrexate could be helpful for me, and what effect it could have on my bone density.
There are two ways in which you may ingest the immunosuppressant, Methotrexate – as a pill or injection. Some patients – those with gastrointestinal issues (patients with poor intestinal absorption), benefit from the injection. It is more available to the body than the pill. If you fall into the group of patients who suffer with GI issues you can go for the injection. There is no difference in its bioavailability. If you choose the injectible form, you needn’t concern yourself with its efficacy. There is no difference in efficacy or safety in bioequivalent doses.
However, without GI issues, you’d be advised to stay with the pill. There’s no significant difference in infection rates and it’s more convenient than the injection – no trips to the doctor, no needles, and no syringes.
As to your bone loss concerns, higher doses have been associated with bone loss, as have other immunomodulating/disease modifying (DMARD) drugs. Since inflammation itself leads to bone loss and Methotrexate in whatever form lowers inflammation, the final result of taking Methotrexate would be less bone loss overall.