Methotrexate For Rheumatoid Arthritis
Rheumatoid arthritis is a chronic condition that occurs when the immune system attacks healthy joints. Doctors may treat the resulting inflammation and pain with methotrexate, a drug that suppresses the immune system.
Since the 1940s, doctors have used methotrexate as a treatment for cancer. In the 1980s, scientists discovered that it could also help ease the pain and swelling of RA, as well as other symptoms of the condition. Three years later, the Food and Drug Administration approved the drug for this purpose, and it is now a first-line treatment for RA.
Methotrexate is a disease-modifying antirheumatic drug . This means that it is one of a group of drugs that changes the course of RA and can slow its effect on the joints.
In this article, we explore methotrexate for RA, including the average dosages and safety considerations.
The average dosage of oral methotrexate for RA starts at 7.510 milligrams weekly. This is equivalent to 3 or 4 pills taken once a week. If necessary, a doctor can raise the dosage to 25 mg per week or more, depending on what a person can tolerate. A 2017 review notes that methotrexate alone can significantly reduce the progression of RA at dosages of 7.525 mg per week .
A persons RA may respond better to a combination of methotrexate and another DMARD. Researchers have yet to determine conclusively whether a single-drug or a combined approach is more effective.
How And When Is Methotrexate Taken
Methotrexate can be taken as a tablet, liquid or injection.
Methotrexate should be taken on the same day once a week. Youll be given a starting dose of methotrexate while your rheumatologist tries to bring your condition under control, but this might be increased if it isnt helping your symptoms.
Methotrexate tablets come in two strengths: 2.5 mg and 10 mg. To avoid confusion, its recommended you only be given one strength, usually 2.5mg. If you are prescribed both tablet strengths be very careful not to confuse them, as they can look quite similar.
If you are starting methotrexate injections, you’ll usually be given your methotrexate injection by a health professional. They will often show you how to inject yourself using either a syringe or injector pen, so you can do it at home. Let them know if you think you will have difficulty injecting yourself.
You must always wash your hands before and after handling methotrexate.
Methotrexate With Other Medicines
Methotrexate interferes with the absorption of B vitamins, such as folic acid, from the diet. Because of this, a supplement of folic acid is usually prescribed but MUST NOT be taken on the same day as methotrexate.
Folic acid:
- is needed for normal cell division, especially in infancy
- is needed in the production of red blood cells
- must be taken on a separate day from the weekly methotrexate
The antibiotics co-trimoxazole and trimethoprim should not be taken whilst on methotrexate.
Additional disease modifying anti-rheumatic drugs or biologic medications may be prescribed in conjunction with methotrexate.
Remember to take care when using any other medications or complementary therapies . Remember to check with your doctor, nurse or pharmacist that they are safe to take with methotrexate and any other medication taken.
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Mechanisms Of Cardiovascular Disease Reduction By Methotrexate
The exact mechanism of MTXs anti-inflammatory action in RA remains uncertain. It is probably mediated by accumulation of adenosine , a potent endogenous anti-inflammatory mediator, but there are also significant effects on T-cell activation . Systemically, MTX has been shown to reduce CRP, IL-6 and TNF, cytokines known to drive the development of atherosclerosis . In vivo, MTX has been shown to downregulate foam cell production and increase expression of antiatherogenic reverse cholesterol-transport protein .
This suggests that the antiatherogenic actions of MTX may not be confined to an anti-inflammatory effect. MTX does not appear to have a significant effect on the levels of serum LDL and HDL cholesterol and does not appear to affect platelet function or other procoaguable factors that may be contributing to excess CVD in RA . These findings are summarized in .
Is Methotrexate Right For You
The reality is that methotrexate can be a very effective treatment option in helping patients reduce the joint damage associated with RA. This, in turn, can reduce pain, improve mobility and function, and increase a patients overall quality of life. Thus, many doctors prescribe the typical dose of methotrexate for RA treatment.
Despite its long history of safety, many patients still worry about the drugs negative side effects. This is likely because theyve heard about the side effects methotrexate can cause in patients with breast cancer or other types of cancer commonly treated by methotrexate.
It is important to keep in mind that these particular patients take very, very high doses of methotrexate much higher than the doses used in RA treatment. Not surprisingly then, their side effects tend to be more prevalent and more severe due to the patient being exposed to higher levels of the drug.
To find out if methotrexate is a good choice for helping you manage your RA, talk to your doctor about whether its the right treatment for you individually. If youre prescribed methotrexate, be sure to take it exactly as the doctor prescribes for maximum treatment benefits with the lowest risk of side effects. If youre unsure what that correct dose is or how to take it, your doctor or pharmacist can answer those types of questions for you.
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Fertility Pregnancy And Breastfeeding
Women using this drug should use contraception or encourage their partner to. Talk to your doctor as soon as possible if youre planning to start a family.
You shouldn’t take methotrexate if you’re pregnant or trying for a baby, as it can affect how an unborn baby develops.
Methotrexate should be stopped three months before you become pregnant. If you become pregnant while taking methotrexate or if you’ve had less than a three-month break from the drug, it’s important to speak to your doctor as soon as possible.
It used to be recommended that men stop methotrexate three months before trying for a baby, but research now shows it’s fine for men to continue taking methotrexate when trying for a baby with their partner.
If you are planning to try for a baby it’s important to take folic acid to support the health of you and your baby.
You shouldnt breastfeed if youre on methotrexate, as the drug could pass into breast milk, and we yet dont know what effects this could have on a baby.
Your doctors will usually recommend going straight back onto methotrexate once youve finished breastfeeding. This is because the sooner you can get back onto your medication, the lower the risk of having a flare.
What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
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What Is The Prognosis For People Who Have Rheumatoid Arthritis
Although there is no cure for rheumatoid arthritis, there are many effective methods for decreasing the pain and inflammation and slowing down the disease process. Early diagnosis and effective treatment are very important.
Extensive research is being done to learn the cause of rheumatoid arthritis and the best methods of treatment.
Last reviewed by a Cleveland Clinic medical professional on 11/17/2017.
References
What Is Rheumatoid Arthritis
In rheumatoid arthritis , your immune system recognizes your joints as foreign to your body and attacks the fluid inside them, called the synovium. This can affect people in different ways, depending on how severe the disease has gotten. RA can cause:
-
Inflammation, redness, and swelling
-
Joint deformities
There is no cure for RA, but certain medications like can help slow down how quickly the disease worsens.
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Imaging Tests Can Tell You If Methotrexate Is Working To Prevent Joint Damage
Imaging tests, including x-rays, MSUS and magnetic resonance imaging , are used to diagnose rheumatoid arthritis and can also be used to check for worsening joint damage while youre on methotrexate.
These radiographic tests are used to detect inflammation, bone erosions and joint space narrowing, which indicate that rheumatoid arthritis is damaging your joints. MUSU and MRI are better at picking up bone erosion and inflammation than x-rays.
When methotrexate works it helps to slow joint damage and the progression of rheumatoid arthritis. In some people taking methotrexate, no or limited damage may be picked up on these tests . However, methotrexate isnt always able to prevent disease progression, especially in people with severe rheumatoid arthritis.
Reduction Of Joint Stress
Because obesity stresses the musculoskeletal system, ideal body weight should be achieved and maintained. Rest, in general, is an important feature of management. When the joints are actively inflamed, vigorous activity should be avoided because of the danger of intensifying joint inflammation or causing traumatic injury to structures weakened by inflammation. On the other hand, patients should be urged to maintain a modest level of activity to prevent joint laxity and muscular atrophy. Splinting of acutely inflamed joints, particularly at night and the use of walking aids are all effective means of reducing stress on specific joints. A consultation with a physical and an occupational therapist is recommended early in the course.
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Psoriasis On Different Skin Tones
Psoriasis on darker skin may be a dark brown or violet with gray scales. On light skin, it’s usually red with white or silvery scales.
Psoriatic Arthritis
Psoriatic arthritis involves both psoriasis and joint pain. Methotrexate is given off-label for PsA.
The weekly adult dose of pill or injectable methotrexate for PsA is:
- A starting dose of 7.5 mg
- A typical maintenance dose of 15 mg
- A maximum dose of 25 mg, if needed
What Are Standard Dosages For Methotrexate
Most people with RA begin with a 7.5 milligram dose of methotrexate tablets taken once a week. Over time, if that is not enough to help, your doctor will increase your dosage, perhaps to 20 milligram.
It is extremely important to understand that the drug is taken once weekly, not once each day, Tenpas says, noting that mistaking this dosage has led to toxicity in some patients.
Methotrexate can also be given by injection. People can give the methotrexate shot to themselves using an auto-injector. Taking the drug this way allows more of it to get into your system without increasing unwanted side effects.
Starting dosages for the injected drug are generally similar as for the oral version.
Rheumatoid arthritis is a chronic inflammatory disease that affects many joints, mainly the small joints of the hands and feet. It is a lifelong condition without a cure.
RA occurs when the immune system malfunctions and attacks healthy tissues. Untreated or severe RA can cause inflammation that also affects the organs. When RA attacks the joints, its target is the synovium . Over time, chronic inflammation can lead to bone erosion and joint deformity.
There is no permanent cure for RA. However, healthcare providers have many options for treating RA symptoms and getting the disease into remission. Remission is a time in which a person experiences few or no signs of the disease.
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Why Is This Medication Prescribed
Methotrexate is used to treat severe psoriasis that cannot be controlled by other treatments. Methotrexate is also used along with rest, physical therapy, and sometimes other medications to treat severe active rheumatoid arthritis that cannot be controlled by certain other medications. Methotrexate is also used to treat certain types of cancer including cancers that begin in the tissues that form around a fertilized egg in the uterus, breast cancer, lung cancer, certain cancers of the head and neck, certain types of lymphoma, and leukemia . Methotrexate is in a class of medications called antimetabolites. Methotrexate treats cancer by slowing the growth of cancer cells. Methotrexate treats psoriasis by slowing the growth of skin cells to stop scales from forming. Methotrexate may treat rheumatoid arthritis by decreasing the activity of the immune system.
Measures To Reduce Bone Loss
Inflammatory conditions such as rheumatoid arthritis can cause bone loss, which can lead to osteoporosis. The use of prednisone further increases the risk of bone loss, especially in postmenopausal women.
You can do the following to help minimize the bone loss associated with steroid therapy:
- Use the lowest possible dose of glucocorticoids for the shortest possible time, when possible, to minimize bone loss.
- Get an adequate amount of calcium and vitamin D, either in the diet or by taking supplements.
- Use medications that can reduce bone loss, including that which is caused by glucocorticoids.
- Control rheumatoid arthritis itself with appropriate medications prescribed by your doctor.
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Can I Stop Taking Methotrexate For Rheumatoid Arthritis
Myth: You can stop taking methotrexate once you feel better
You may feel much better than you did before you started methotrexate: less pain, swelling, morning stiffness or fatigue. If you feel better but still have low disease activity, the ACRs treatment guidelines recommend against stopping or lowering your dose.
What Should I Tell My Doctor Before Starting Humira
Tell your doctor about all of your health conditions, including if you:
- Have an infection, are being treated for infection, or have symptoms of an infection
- Get a lot of infections or infections that keep coming back
- Have TB or have been in close contact with someone with TB, or were born in, lived in, or traveled where there is more risk for getting TB
- Live or have lived in an area where there is an increased risk for getting certain kinds of fungal infections, such as histoplasmosis, coccidioidomycosis, or blastomycosis. These infections may happen or become more severe if you use HUMIRA. Ask your doctor if you are unsure if you have lived in these areas
- Have or have had hepatitis B
- Are scheduled for major surgery
- Have or have had cancer
- Have numbness or tingling or a nervous system disease such as multiple sclerosis or Guillain-Barré syndrome
- Have or had heart failure
- Have recently received or are scheduled to receive a vaccine. HUMIRA patients may receive vaccines, except for live vaccines. Children should be brought up to date on all vaccines before starting HUMIRA
- Are allergic to rubber, latex, or any HUMIRA ingredients
- Are pregnant, planning to become pregnant, breastfeeding, or planning to breastfeed
- Have a baby and you were using HUMIRA during your pregnancy. Tell your babys doctor before your baby receives any vaccines
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How To Cope With Side Effects Of Methotrexate
What to do about:
- loss of appetite, feeling or being sick, stomach ache or indigestion eat simple meals and do not eat rich or spicy food. It can help to eat and drink slowly and have smaller, more frequent meals. If you’re being sick, try taking small, frequent sips of water to avoid dehydration. For stomach ache, putting a heat pad or covered hot water bottle on your stomach may help.
- diarrhoea drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
- headaches, feeling tired or drowsy rest and drink plenty of water. Do not take non-steroidal anti-inflammatories, such as ibuprofen. You can try a painkiller such as paracetamol. Do not drink too much alcohol. Do not drive, cycle or use machinery if you feel tired or drowsy. Speak to your doctor if this does not get better.
- hair loss this is unlikely to be permanent. If hair loss bothers you, talk to your doctor. They may be able to lower your dose or recommend a different medicine.
What About Side Effects
Methotrexate can cause mouth ulcers in a few patients, in the beginning of treatment. This should go away with time. Another possible side effect is nausea and vomiting. Methotrexate can also cause hair thinning or hair loss. In rare cases some people may develop lung problems.
Methotrexate can cause mild liver irritation. Please tell your doctor if you have a history of any alcohol abuse, hepatitis, yellow jaundice, or liver disease. While on methotrexate you must limit yourself to 2 alcoholic beverages per week. Blood work will be done every 4-12 weeks to check your liver function. This blood work will also include a complete blood count since methotrexate can also cause a decrease in blood counts. This blood work is very important. It allows the rheumatologist to make timely changes to your dose of methotrexate if there is ever problem.
Methotrexate is known to cause birth defects in the children of both men and women taking this drug. If you are pregnant, considering having a child, or nursing, discuss this with your rheumatologist before beginning this medication. You must use an effective form of birth control while taking methotrexate and for at least 3 months after the methotrexate is stopped. Your rheumatologist or nurse can give you additional guidance.
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