Methotrexate for Rheumatoid Arthritis (RA)

METHOTREXATE has become the GOLD STANDARD or most preferred drug for rheumatoid arthritis. Generally, it is safe. Research has shown that patients who take these medications have fewer chances of joint damage, death and that it also prolongs the life span of those who have rheumatoid arthritis. The risks are acceptable and benefits are great.

Methotrexate is an ‘antimetabolite’ which interferes with folic acid production, DNA production, and cellular reproduction. It is commonly used in the treatment of rheumatoid arthritis to suppress an overactive immune system that is causing inflammation and damage to the joints and other organs. Methotrexate is one of the several Disease-Modifying Antirheumatic Drugs (DMARDs) which are able to slow the progression of the disease. Methotrexate is available as oral tablets or injection. The tablets are usually taken once a week with or after food. Methotrexate can cause nausea and vomiting at the start of therapy, but if the weekly dose is increased slowly, your body system will usually get used to it. This drug does not work immediately. It may be weeks to months before you notice any benefit.

Thus it is important that you take your medication regularly, otherwise, you may not receive any benefit at all. Methotrexate can be taken with other medicines used for rheumatoid arthritis, such as corticosteroids. Avoid immunization (vaccination), especially with live vaccines, unless approved by your doctor. Also, avoid direct contact with persons who have taken oral polio vaccine or those with infections. Do not drink alcohol while on this medicine as alcohol can increase the chance of liver problems. Please inform your doctor or pharmacist if you are taking other medications, including traditional remedies, that he is not aware of. Many methotrexate users experience no, or minor, side effects when the drug is taken according to your doctor’s instruction. However certain unwanted effects may occur. You may be given folic acid supplements to prevent these side effects or folinic acid to reverse them.

Side effect Warning signs To reduce this side effect
Nausea or Vomiting or Diarrhoea or Stomach pain Take medication after food or divide the dose to be taken within the day. Inform your doctor immediately if you see bloody vomit or stools. Consult your doctor or pharmacist if you vomit shortly after taking a dose of methotrexate or if you have forgotten to take your medication for a few days
Loss of hair May not be obvious Reversible when the drug is discontinued
Allergic reaction or Photosensitivity Is very rare skin rashes or itching, flushing or redness of skin, severe sunburn These usually resolve readily on stopping treatment or with dose reduction. Stay out of strong sunlight.
Lung inflammation is very rare Persistent coughing or breathlessness or chest pain The drug should be stopped
Liver disorder or irritation is very rare when the doctor is monitoring you Yellow eyes or skin or dark urine or constant abdominal pain The drug should be stopped. Avoid all alcohol Tell your doctor if you previously had jaundice or hepatitis
Blood disorder (rare) There may be no warning signs but unusual bleeding or bruising, lip or mouth ulcers with ‘flu-like’ symptoms may occur (Note: occasional minor mouth ulcers without fever is harmless) Inform your doctor immediately if these symptoms occur Monitoring of the effects of your new treatment is important, particularly during the first three months of treatment. To do this we may need to check your blood tests regularly. The monitoring is for your safety

SPECIAL PRECAUTIONS While taking methotrexate, you may be more susceptible to infections; see a doctor immediately if you develop fever or if you feel generally unwell.

You SHOULD NOT get pregnant when on this medication.. As with all medicines, it is important to inform your doctor if you intend to conceive or breast-feed while taking this medicine.