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Methotrexate for Rheumatoid Arthritis & Psoriatic Arthritis
For several decades, Methotrexate, a safe, effective, and relatively inexpensive disease-modifying anti-rheumatic drug (DMARD, has been the preferred treatment for people with moderate to severe rheumatoid (RA) and psoriatic arthritis (PSA).
MTX is an anti-metabolite that interferes with the way cells utilize essential nutrients, in this case folic acid. In addition to its ability to inhibit the activity of our immune system and reduce inflammation associated with RA and PSA, MTX can also slow the growth of cancer cell when prescribed in a different dose and schedule.
Depending on the patient, MTX can be taken as a pill by mouth or as an injection. When taking the oral form, all the prescribed pills should be taken together, at the same time, or in two 12-hour interval, on the same day, each week. For those who cannot tolerate the pill form due to gastrointestinal problems, MTX can also be given as weekly injection, just beneath the skin.
Usually, MTX is started at 7.5 mg once a week, and gradually increased as needed, up to a maximum of 25mg per week. Because it takes up to four weeks to take effect, NSAIDs (non-steroidal anti-inflammatory drugs) or corticosteroids are usually continued to control your symptoms. However, when the MTX kicks in, these medications may be decreased. Although MTX and NSAIDs may interact with each other, they can be taken together.
Common side effects may include nausea, vomiting, loss of appetite, and mouth ulcers. However, these side effects can decrease and even disappear with usage. In order to reduce the incidence or severity of side effects, folic acid, 1mg daily except on the day you take MTX, can be very helpful.
One important side effect that needs to be closely monitored is the very rare complication of liver damage. While taking MTX, liver functions should be monitored via blood tests, usually every two months and it should not be taken while you are pregnant or breastfeeding. Furthermore, because alcohol and MTX both have the potential to affect your liver, it is advised that alcohol consumption be reduced or even eliminated, except for a special occasion, like your spouse’s birthday or anniversary.
By Dr. Yong H. Tsai
Published in The Daytona Beach News-Journal
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