Methotrexate for Rheumatoid Arthritis
One of the classes of medications used in the treatment of rheumatoid arthritis (RA) is that of the disease modifying anti-rheumatic drugs or DMARDs. This class includes drugs such as penicillamine, Plaquenil, and Methotrexate. Methotrexate is considered by many to be the gold standard for DMARDs and is widely used to treat RA as well as other conditions such as lupus. Other names for these kinds of medications are immunosuppressive drugs or also SAARDs, or slow acting anti-rheumatic drugs.
Methotrexate was originally designed to be used as chemotherapy for leukemia but was used to treat RA as early as the 1950’s. Methotrexate or MTX works by suppressing the immune system. Since RA is an autoimmune disease in which the body’s normal defenses malfunction and attack normal tissues, turning down the immune response decreases the effects of the disease. MTX can help to prevent joint damage and damage to other organs affected by RA.
Methotrexate interferes with the use of folates (folic acid) an essential nutrient, so supplements of these are often given after treatments with the drug to decrease side effects. (Never take such supplements on your own when taking MTX. Only take them as directed by your physician) One of the most common side effects is nausea, especially when the drug is given by mouth. Giving it as an injection may decrease the amount of nausea or even eliminate it. The dosage of MTX for lupus or arthritis is quite a bit less than that used as cancer chemotherapy and the effects are not nearly so bad.
Lower doses of MTX can be given when used in combination with other drugs and this produces good results with fewer of the side effects. Some of the adverse effects of Methotrexate include nausea and vomiting, hair loss, diarrhea, mouth sores, rashes, fatigue, body aches, and elevated liver enzymes from inflammation of the liver. One of the most troubling adverse effects is an increased risk for certain cancers. Since the immune system is being suppressed, there is also always an increased risk of infections which can be serious.
Despite some side effects and risks, Methotrexate
is so effective in suppressing inflammation and damage in rheumatoid
arthritis that virtually every patient who can tolerate it will be
tried on the drug. For most patients, it is well tolerated and the
benefits far exceed the problems. MTX has been a valuable part of
the current successful treatment picture for those millions
confronted by RA.
Resources
Comprehensive information about RA and its treatment: arthritis.about.com/
Methotrexate as a treatment for RA www.hopkins-arthritis.org/
Methotrexate in Juvenile Rheumatoid Arthritis: content.nejm.org/
Dosage and other Methotrexate information: www.medicinenet.com/