Part 5: Dealing with Risks & Dangers: Methotrexate and Rheumatoid Arthritis

Common issues with methotrexate for RA

About 90 percent of people with Rheumatoid Arthritis will take methotrexate at some point. The majority will take if for more than 5 years. Fortunately, the risk of serious complications is small and can be reduced even further by proper monitoring.

Most issues with methotrexate are not considered medically serious. This includes, mouth ulcers, digestive upset, hair thinning, fatigue, and headaches. Usually, folic acid is prescribed to help thwart side effects before they happen. The dose of folic acid may be increased to decrease side effects.

However, certain more serious complications can occur. Before beginning methotrexate therapy, doctors usually run a complete blood count (CBC), a liver panel, and a chest x-ray. This is used to identify patients for whom methotrexate is not a safe therapy. This includes patients with a history of heavy alcohol use or who have had tuberculosis or other lung diseases or liver diseases.

Precautions

Patients on methotrexate therapy require regular monitoring by a doctor to screen for serious complications. Standard blood tests can usually identify most issues with liver, kidneys, or lowered blood counts. The tests are repeated approximately every six to twelve weeks so that problems can be detected early. Discontinuing methotrexate therapy can prevent permanent complications.

There is a small risk of pneumonitis with methotrexate. This is a dangerous complication that can occur at any time. Patients should report any persistent dry cough to their doctors immediately. X-rays may be required.

Other common precautions include:

Pregnancy must be avoided because methotrexate causes miscarriage or birth defects.
Tell every doctor and pharmacist if you are using methotrexate. It can causes interactions with many drugs, prescription and over the counter.
Methotrexate may need to be discontinued before surgery or certain other medical treatments.
Alcohol use must be limited. Some doctors allow 2 drinks per week or prohibit alcohol entirely. Others are more liberal.
A stomach acid inhibitor may be prescribed to help prevent stomach ulcers.
Avoid sun exposure and use high level sunscreen to prevent severe sunburn due to increased sun sensitivity.
Since methotrexate reduces immune activity, precaution should be taken to avoid infection.