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Rheumatoid Arthritis and Methotrexate

Disease modifying anti-rheumatic drugs (DMARDs) have been shown to improve radiographic outcomes. The effect of these agents can be different than other drugs and its onset may be more delayed than that of either NSAIDs or corticosteroids.

Methotrexate is considered as the first-line DMARD agent for most patients with RA. It has a relatively rapid onset of action at therapeutic doses (6-8 weeks), good efficacy, favorable safety profile, is easy to administer, and is relatively low in cost.

Effect of Methotrexate on Rheumatoid Arthritis

Disease modifying anti-rheumatic drugs (DMARDs) seem to work by preventing the immune cells from attacking the connective tissues and Methotrexate specifically interferes with the way cells use essential nutrients. Because of this, methotrexate is able to inhibit the activity of the immune system, consequently reducing inflammation. It is effective in reducing the signs and symptoms of RA, as well as slowing connective tissue damage. Significant improvement seems to occur within the first two months of treatment. Many patients experience consistent improvement over months or even years.

Read more details about Methotrexate.

How to Use Methotrexate

Methotrexate is prescribed to patients with severe active rheumatoid arthritis that cannot be controlled by other medications. Methotrexate is also used to treat certain types of cancer, and psoriasis.

Methotrexate is available in oral and injectable forms. The dosage schedule depends on how your body responds to the medication. Based on a study published in the Annals of the Rheumatic Diseases, the optimal evidence- base dosing and routing recommendations are as follows:

Starting dose: 15 mg/week orally, increasing by 5 mg/month to 25–30 mg/week, or the highest tolerable dose.

In case of an insufficient response, a subsequent switch to subcutaneous administration can be considered.

The improvement of symptoms may be noticeable after 3 to 6 weeks of drug administration. The full benefit of methotrexate may occur after 12 weeks or longer. Methotrexate must be taken exactly as directed. Patients prescribed with this medication should continue to taking it even if they already feel well. The treatment should not be discontinued without the doctor's advice.

What are the precautions when taking this medicine?

• Talk with healthcare provider before receiving any vaccinations. Use with this medicine may either increase the risk of serious infection or make the vaccination less effective.

• If you have had hepatitis B or C, talk with healthcare provider.

• If you have drug or alcohol addiction, talk with healthcare provider.

• If you have kidney disease, talk with healthcare provider.

• If you have liver disease, talk with healthcare provider.

• If you have a weakened immune system, develop infections easily, or are on antibiotics, talk with healthcare provider.

• If you have mouth sores, stomach irritation or ulcers, talk with healthcare provider.

• Do not donate blood while using this medicine and for 1 month after stopping.

• Check medicines with healthcare provider. This medicine may not mix well with other medicines.

• Talk with healthcare provider before using aspirin, aspirin-containing products, other pain medicines, blood thinners, garlic, ginseng, ginkgo, or vitamin E.

• Avoid alcohol (includes wine, beer, and liquor).

• You can get sunburned more easily. Avoid sun, sunlamps, and tanning beds. Use sunscreen; wear protective clothing and eyewear. Continue to protect yourself against sunburn for at least a month after methotrexate therapy.

• Use birth control that you can trust to prevent pregnancy while taking this medicine.

What are some possible side effects of this medicine?

• Anemia, low white blood cell count, and low platelet count.

• Risk of infection. Avoid people with infections, colds, or flu.

• Nausea or vomiting. Small frequent meals, frequent mouth care, sucking hard, sugar-free candy, or chewing sugar-free gum may help.

• Not hungry.

• Diarrhea.

• Mouth irritation. Frequent mouth care with a soft toothbrush or cotton swabs and rinsing mouth may help.

• Sore throat.

• Headache.

• Hair loss. Hair usually grows back when medicine is stopped.

• Kidney failure can rarely occur.

• Liver damage can rarely occur.

• Lung damage can rarely occur.

• Other forms of cancer can rarely occur later in life.

Reasons to call healthcare provider immediately

• If you suspect an overdose, call your local poison control center or emergency department immediately.

• Signs of a life-threatening reaction. These include wheezing; chest tightness; fever; itching; bad cough; blue skin color; fits; or swelling of face, lips, tongue, or throat.

• Signs or symptoms of infection. These include a fever of 100.5 degrees or higher, chills, severe sore throat, ear or sinus pain, cough, increased sputum or change in color, painful urination, mouth sores, wound that will not heal, or anal itching or pain.

• Chest pain or pressure.

• Difficulty breathing.

• Persistent cough.

• Pinpoint red spots on skin.

• Severe belly pain.

• Severe nausea or vomiting.

• Severe diarrhea.

• Not able to eat.

• Unusual bruising or bleeding.

• Dark urine or yellow skin or eyes.

• Feeling extremely tired or weak.

• For females, if you become pregnant while taking this medicine.

• Any rash.

• No improvement in condition or feeling worse.

References

drugs.com

Conquering rheumatoid arthritis: an illustrated guide to understanding the ...By William Bensen, Wynn Bensen

Progress In Drug Research, Volume 49 Ernst Jucker

The Everything Health Guide to Arthritis By Carol Eustice

http://ard.bmj.com/content/68/7/1094

Principles of ambulatory medicine By Nicholas H. Fiebach, Lee Randol Barker, John Russell Burton, Philip D. Zieve

http://www.healthcentral.com/rheumatoid-arthritis/c/53/5871/dirty/

The chemotherapy source book By Michael Clinton Perry

Rheumatoid Arthritis and Methotrexate

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