Saturday, May 18, 2024

Is Methotrexate Safe For Rheumatoid Arthritis

What Its Used For

What are the side effects of methotrexate injection in Rheumatoid Arthritis? – Dr. Yogesh Singh

Methotrexate is still used intravenously in high doses to treat cancer. But its most common use now is in rheumatoid arthritis and other inflammatory conditions. Low-dose methotrexate was shown to be effective in rheumatoid arthritis in 1985. It is now a drug of first choice for rheumatoid arthritis.

Methotrexate is also used as an intra-muscular injection to terminate ectopic pregnancy, as an alternative to surgery.

Other Immunomodulatory And Cytotoxic Agents

Some additional immunomodulatory drugs are used in RA including azathioprine , and cyclosporin A . Rarely cyclophosphamide and d-Penicillamine are used. Because the potential of high toxicity, these agents are typically utilized for life-threatening extra-articular manifestations of RA such as systemic vasculitis or with severe articular disease that is refractory to other therapy.

Azathioprine has some activity in rheumatoid arthritis but may take 8-12 weeks to see an effect. It is a purine analog that can cause bone marrow suppression and lowering of blood cell counts particularly in patients with renal insufficiency or when used concomitantly with allopurinol or ACE inhibitors. Increased risk of secondary malignancy due to azathioprine is controversial. Screening for levels of the enzyme thiopurine methyltransferase is recommended before initiating therapy with azathioprine. Certain individuals have deficiencies in this enzyme that metabolizes azathioprine with a concomitantly increased risk of toxicitiy for the medication. Side effects include nausea, and alopecia. Blood tests to monitor blood counts and liver function tests are necessary for patients on azathioprine.

Side Effects Are Par For The Course For All Medications But Which Ra Drugs Carry The Least Amount Find Out Here

by Health Writer

If you suspect you may have rheumatoid arthritis or your doctor has recently diagnosed youthen youre probably already experiencing the classic symptoms of painful, achy, and swollen joints, especially first thing in the morning or after a long day sitting at work.

Unlike other types of arthritis that can be brought on by too much activity, rheumatoid arthritis symptoms tend to happen when youve been at rest, not using your joints. Maybe you wake up in the morning and feel stiff. Or maybe you get out of the car after a long trip and find your body will barely move. The discomfort in your joints is the result of an overactive immune system that mistakenly attacks the tissue that lines your joints. The result is pain and inflammation and, over time, damage to the joints that can lead to deformity and disability. You may not know anyone else with the disease, but if you have rheumatoid arthritis, youre in good company: RA is the second most common type of arthritis, affecting 1.3 million Americans.

The good news about rheumatoid arthritis is that there are many different treatment options. When someone comes in with rheumatoid arthritis, I tell them that I can get them feeling better and halt the progression of their disease, says Rebecca Blank, M.D., Ph.D., a rheumatologist at NYU Langone Health in New York City. The question is, which treatments work best and which ones are safest? Start with these joint-saving options.

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Impacts Of Sun Exposure And Arthritis Medication

It is important to look out for these types of reactions when taking certain medications.

Drugs that make you sun sensitive include NSAIDs, sulfa containing drugs and antimalarials. Naproxen appears to have the most photosensitizing potential of all the NSAIDs and is a common cause of sunburn reaction. Sunburn reaction from ibuprofen seems less common. The use of celecoxib can cause a sun rash reaction.

Methotrexate is often listed as causing sun sensitivity. However, methotrexate is not, in fact, a sun sensitizing drug, but rather produces a reaction called radiation recall. Areas where patients have had sunburns in the past may react again after starting methotrexate.

Sulfasalazine more commonly causes sunburn reactions, but sun rash has also been reported.

Hydroxychloroquine, an antimalarial, is another well-known cause of drug-induced sun sensitivity.

At this point there is little evidence on which of the biologic response-modifying agents cause sun sensitivity, or the resulting reactions that may develop.

  • avoid direct sun exposure 11 am to 4 pm
  • wear long-sleeved shirt and pants
  • wear a wide-brimmed hat
  • use sunscreen SPF 30 or higher
  • sunscreens with titanium dioxide or zinc oxide are preferred, but some people get skin reactions from them
  • if that is the case, look for sunscreen with combinations of one or more of the following ingredients: Mexoryl SX, Mexoryl XL, avobenzone, Tinosorb S, or Tinosorb M
  • apply sunscreen 15-30 minutes before you are out in the sun
  • Talk With Others Who Understand

    Methotrexate and pregnancy: Effects and how to stay safe

    On myRAteam, the social network for people with rheumatoid arthritis, more than 189,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.

    Are you taking methotrexate for RA? Share your experience and tips in the comments below or by posting on myRAteam.

    Read Also: What Does Arthritis Do To The Body

    Treating Ra With Methotrexate

    Methotrexate is a type of DMARD. DMARDs are a class of medications often used in the early stages of RA. A few drugs in the DMARD class were specifically made for treating RA, but methotrexate was developed for a different reason. It was originally created to treat cancer, but its been found to work for RA too. Its sold under the brand names Rheumatrex and Trexall. It comes as an oral tablet and a solution for injection.

    Methotrexate and other DMARDs work to reduce inflammation. They do this by suppressing your immune system. There are risks linked with keeping your immune system in check this way, though, including an increased risk of infections.

    While methotrexate comes with the chance of side effects, it also offers great benefits for people with RA. DMARDs can prevent joint damage if you use them early enough after your RA symptoms first appear. They can also slow down further joint damage and alleviate symptoms of RA. Most doctors and people with RA think the benefits of this medication are worth the risks.

    Methotrexate is a long-term drug when used for RA. Most people take it until it no longer works for them or until they can no longer tolerate its effects on their immune system.

    How Could Kratom Help With Ra Symptoms

    People with RA sometimes self-administer kratom to help manage three major symptoms of the condition: joint pain, depression, and anxiety.

    In a survey of 2,700 kratom users in the U.S. conducted by Johns Hopkins Medicine 91 percent of respondents reported using kratom for pain relief . Additionally, 67 percent reported taking kratom to help alleviate anxiety, and 65 percent said they used it to manage depression.

    In line with this survey, much of the research on self-reported kratom ingestion mentions taking the drug to ease pain. Animal studies have also suggested that the mitragynine in kratom may reduce anxiety by lowering the levels of stress hormones in the body.

    Some people try kratom as an alternative to opioid painkillers. Research from 2019 indicates that up to 40 percent of people with RA take opioid-based drugs. Although opioids can be effective in managing pain, they pose a risk of addiction and, if abused, can be fatal. Kratom can have opioidlike effects when used and may be safer, in some regards, than opioids one review assessed the risk of overdose death from opioids to be more than 1,000 times greater than the risk of death from kratom.

    Although kratom may pose a lower risk of death compared to opioid misuse, do not take it without first consulting your rheumatologist or health care team. Your doctor is best suited to evaluate the overall safety of the drug and its potential impacts on your health and your RA treatment plan.

    Read Also: Do You Get A Rash With Rheumatoid Arthritis

    Are Biologics Safer Than Methotrexate

    Oral drugs such as methotrexate can cause non-serious immediate side effects such as nausea and GI issues. They can also cause hair loss. “With biologics, we dont see those immediate side effects, but they have a potential for more serious side effectseven though we dont see them often, says Dr. Sharmeen. The most common biologics side effect is a skin reaction at the injection site. The most severe side effects are the potential for infection, including the reactivation of conditions such as tuberculosis and hepatitis B, increased risk of certain cancers, and liver damage.

    Will Methotrexate Mess Up My Immune System

    What is the role of methotrexate in Rheumatoid Arthritis? – Dr. Yogesh Singh

    Methotrexate tinkers with the immune system, but it doesnt suppress it in the same way that some other RA drugs do. So taking methotrexate is rarely associated with increased infection risk unless youre also taking other medications at the same time, such as glucocorticoids, immunosuppressive disease-modifying antirheumatic drugs , or biologics. There may be slight increase in infection, Dr. Feldman notes, but were talking about a half a cold per year per person.

    Doctors may recommend patients with severe infections take a break from methotrexate while they recover, but you can still take it while you have minor infections like an upper respiratory virus or urinary tract infection. However, you should let your rheumatologist know if you have an infection that doesnt get better after a few days, to make sure it doesnt develop into something more serious.

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    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.

    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.

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    How Do Dmards Treat Ra

    RA involves inflammation that damages peopleâs joints over time, which can lead to pain, stiffness, and reduced mobility. This inflammation occurs due to an overactive immune system that is attacking the bodyâs tissues, especially tissue lining the joints.

    In people with RA, the immune system mistakes healthy tissue in the joints for foreign invaders. It sends cells to attack the joints, which causes them to become inflamed and painful.

    DMARDs help treat RA by blocking or interfering with the actions of these immune cells, which helps to prevent joint damage and slow down the progression of the disease.

    Ra And Methotrexate: Does Methotrexate Reduce Inflammation

    Best of 2019

    Jump to:RA TreatmentMethotrexates HistoryPossible Side Effects Folic Acid & MethotrexateDosingIs Methotrexate for You?

    If you have rheumatoid arthritis , youre probably very familiar with the pain and joint swelling that this particular type of arthritis can cause. If youve had it for some time, you may even be experiencing the joint deformities that can occur as RA progresses. As you know, any joint deformity can take a significant toll on your joint function as well as your overall quality of life.

    RA usually attacks the joints of the hands and feet first, which means even simple activities like tying a shoe, brushing your teeth, combing your hair, or getting dressed in the morning can become painful enterprises. Leisurely pursuits like gardening or taking long walks may have lost their appeal as well, largely as a result of the pain and inflammation these joint-based movements can trigger.

    Although there is currently no cure for RA, there are medications that a doctor can prescribe to slow the progression of joint destruction and deterioration. One of the most popular and also most effective of these is a folate analog called methotrexate . Its a treatment option with one of the longest and most well-established safety profiles of any rheumatoid arthritis drug on the market.

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    Side Effects That Can Occur With Methotrexate

    As with many drugs, people can experience unpleasant, and in rare cases dangerous, side-effects from methotrexate. If you experience anything that concerns you, be sure to speak with your healthcare provider.

    Bothersome side effects include dizziness, headache, tiredness, gastrointestinal upset, mouth sores, rash, diarrhea, and the loss of hair.

    According to the American College of Rheumatology, methotrexate may also lower the ability of the immune system to fight infections.

    How Much Does Methotrexate Cost

    Below are the current prices for the most common prescriptions of each available form of methotrexate.

    Average retail price
    about $435

    Generic methotrexate will be cheaper than the brand-only, auto-injectors. Also, you may be able to save in the long run by asking for a larger prescription . Remember, prices may change over time. Search for your medication on to get the most updated prices.

    Nearly all private and government-funded insurance plans, including Medicare, cover methotrexate. Not as many plans cover Rasuvo because its more expensive, so if you prefer auto-injectors, make sure to ask your insurance plan if they cover it. The manufacturer also offers a program to help you save on your copay. Get more information here.

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    Tumor Necrosis Factoralpha Antagonists

    Medications in the antitumor necrosis factor -alpha class are commonly used in the treatment of RA. These agents have been labeled as class B medications animal studies have shown no harm to the fetus, but thus far, no randomized, blinded, placebo-controlled trials on potential teratogenicity in humans have been completed. Numerous case reports have shown positive outcomes with antiTNF-alpha use in pregnancy, with an incidence of spontaneous abortion and birth defects similar to that in the general population.

    Pregnancy outcomes of 495 women on adalimumab, infliximab, etanercept, certolizumab pegol or golimumab were evaluated in a prospective observational multicenter cohort study and compared with 1532 outcomes from a non-exposed random sample. Major birth defects were reported in 5% of the exposed group as compared to 1.5% in nondiseased controls. The risk of preterm birth was increased, but not the risk of spontaneous abortion. Birth weights adjusted for gestational age and sex were significantly lower in the exposed group compared to the non-exposed cohort .

    The individual TNF inhibitors differ in terms of placental transfer. Certolizumab may have a safety advantage, as smaller amounts of the drug are known to pass into fetal circulation.

    The EULAR guidelines make the following recommendations for use of anti-TNF medications :

    BSR-BHPR guidelines include the following recommendations :

    Can Dmards Treat Ra

    Is methotrexate right for my rheumatoid arthritis?

    Many people understand the function of chemotherapy drugs when they are used to treat cancer. Doctors prescribe these drugs to kill cancer cells or to prevent them from growing and spreading to other parts of the body.

    Many of the DMARDs used for autoimmune disease can be used in cancer treatment along with many other classes of medications but in more intense protocols. These drugs are a common treatment option for autoimmune conditions, such as RA.

    Doctors prescribe these drugs to treat RA at much lower dosages than they would for those with cancer. This is because the goal of treatment is not to kill cancer cells but to change the behavior of the overactive immune cells. The lower dosage also helps to reduce the severity of potential side effects.

    An example of a common DMARD medication used to treat RA is methotrexate. Early treatment with DMARDs and other medications for RA can help slow the progression of the disease and reduce or prevent joint damage and other serious complications.

    DMARDs that doctors may recommend for treating people with RA include:

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    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

    • Bone damage

    • Joint deformities

    There is no cure for RA, but certain medications like can help slow down how quickly the disease worsens.

    Methotrexate Dosage For Autoimmune Disease

    Methotrexate is approved by the Food and Drug Administration for some types of autoimmune arthritis and other autoimmune diseases. It’s used off-label for several other diseases in this category.

    In autoimmune diseases, your immune system mistakenly attacks healthy cells in your body as if they were a virus or bacterium. Methotrexate calms the immune system and lessens the attack.

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