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Answers tagged methotrexate: Page 1 of 2
Q:

Marieanne from Sarnia asks: I was recently diagnosed with rheumatoid arthritis.  I was started on a tapering dose of Prednisone, methotrexate, and hydroxychloroquine.  It has been nearly 3 months and I am still noticing increasing pain and worsening symptoms if I lower my prednisone dose.  Is this normal?

The goal in the treatment of rheumatoid arthritis is to eliminate joint pain, stiffness and swelling while improving function and preventing joint damage.  DMARDs, including methotrexate and hydroxychloroquine, are the class of medications which are used to achieve this goal.  However, they do not always work as well as we want.  It is important to work with your rheumatologist to find the right combination of DMARDs that work for you.  Fortunately, there are many options available, and many patients are able to find success with the right combination.  Until that combination is found, treatment also needs to focus on ensuring best control of your symptoms.  That may include pain relievers, anti-inflammatories, or glucocorticoids such as Prednisone.

The process to find the right treatment combination can be slow in some patients.  That can be frustrating as it sometimes can feel like your health care team will never find the right treatments.  A positive attitude, education around your disease, and working with your rheumatologist and health care team members will help you achieve your goals.

Q:

Iris from Edmonton asks: I have been getting gold injections for rheumatoid arthritis for 35 years, with great results. I think I want to quit. Is it safe for me to quit the gold injections “cold turkey?”

When it comes to quitting most medications for arthritis, it is considered safe to just stop them.  You do not need to do it slowly over time.  This would apply to gold, which was the literal “gold standard” for treating RA years ago, but also to options like methotrexate, hydroxychloroquine, leflunomide, and the biologics.  The only one to be very cautious with is prednisone, which in most cases should NOT be stopped suddenly without input from your physician.

All that said, it is usually best to discuss with your rheumatologist prior to making this decision.  While safe, stopping medication does not mean there will not be consequences.  In particular, your rheumatologist can discuss with you the risk of your RA becoming active again when you stop your medication, and perhaps can provide strategies to help reduce those risks.

Q:

Sherry from Calgary asks: I was just diagnosed with Rheumatoid Arthritis. I was prescribed methotrexate and hydroxychloroquine. I am currently in a flare so need to continue with diclofenac to control the pain. Is this drug combination safe?

There are animal based studies that suggest a concern about using methotrexate and any anti-inflammatory, including diclofenac, together.  However, this combination is used commonly in patients with rheumatoid arthritis without any significant concerns.  It is an appropriate way to control symptoms while waiting for the disease modifying agents, such as methotrexate and hydroxychloroquine, to start working.  While all these medications have potential side effects, there are no significant increased risks when used together.

Q:

Donna from the USA asks: Do I need to continue taking folic acid if I have stopped methotrexate?

Folic acid’s role is to reduce the risk of side effects from methotrexate.  It does not help treat rheumatic conditions itself.  Therefore, in most cases, if the only reason a patient was taking folic acid was because they had been on methotrexate, it would be considered appropriate and safe to stop the folic acid.

Q:

Cathy from the Unites States asks: I am losing my hair from methotrexate.  Is there anything I can do?

While not common, hair loss is a known side effect from methotrexate.  Usually, complete hair loss is not seen at the doses used to treat inflammatory joint and skin conditions, although it certainly can be concerning for individual patients.  Options to reduce this side effect include ensuring you are taking appropriate doses of folic acid, even up to 10 mg per day.  A related medication, called folinic acid, can sometimes be helpful, but should be discussed with your physician.  A dose reduction in methotrexate can also be helpful.  If none of these are effective, have a discussion with your physician to review alternate treatment options.

Q:

Dallas from Edmonton asks: My fiancée and I are getting married in less than a month and we have starting talking about having a family. I’m currently taking Methotrexate injections once a week. We are worried that the methotrexate could increase the chance of birth defects. Has there been any studies done regarding the effects of methotrexate in men when trying to have a baby?

Certainly females should not get pregnant while on methotrexate, with recommendations suggesting that women should stop methotrexate at least 3 months before trying to become pregnant.  The data for men is less clear.  There are rheumatologists who recommend the same for men, avoidance of methotrexate for at least 3 months before trying to conceive.  There are suggestions that methotrexate could affect sperm, however, no study has clearly shown any harmful effects.

Q:

Jen from Edmonton asks: My methotrexate vial says “for intramuscular, intravenous, and intra-arterial use only”, but I am supposed to inject it subcutaneously. Should I be concerned?

Methotrexate use for rheumatic diseases, including rheumatoid arthritis, can be given as a tablet or injection.  For those receiving methotrexate by injection, self-injection is done subcutaneously – under the skin.  An intramuscular injection can also be done, although usually cannot be self-administered.  Methotrexate should not be put directly in a vein or artery for rheumatic diseases.  To learn more about how to do methotrexate self injections, visit our video here.

Q:

Dallas from Alberta asks: I have been on methotrexate for 5 months and started to notice that I am losing my hair.  What should I do?

While not a common occurrence for most people on methotrexate for their arthritis, hair loss certainly is a known side effect.  Certainly this should be discussed with your rheumatologist to determine the best option in any particular case.  For some, increasing folic acid intake may be quite helpful at reversing the hair loss.  For others, lowering methotrexate or considering an alternative may be necessary.  Making the appropriate adjustments with your rheumatologist will ensure the best chance of reducing any side effects while still ensuring your arthritis is, or becomes, under good control.  Keep in mind, even if the hair loss stops, it unfortunately can take months before you notice the improvement.  Hair loss from methotrexate is usually reversible; hair will grow back.

Q:

Audra from Edmonton asks: I am on methotrexate.  Is it safe to get the shingles vaccine?  What about pneumonia?

Vaccines, or immunizations, come in two broad forms.  Most are ok to receive when you have an underlying rheumatic disease and on treatment for it, including methotrexate or even biologics.   For that reason, rheumatologists generally encourage their patients to get the annual flu shot, and to receive the pneumonia vaccine as well.  However, for those vaccines that may have a live component to them, patients may need to be cautious depending on which medication they are on, as you may be at increased risk for developing the condition you are trying to protect yourself from.  While less concerning, these vaccines also may be less effective when on these medications.  If you are able to receive the vaccine before starting them, all the better.  It’s important to discuss the details of any live attenuated vaccine with your rheumatologist to ensure it’s right for you.

Q:

John from Prince George asks: I have been diagnosed with rheumatoid arthritis and have developed nodules on my elbows, hands and feet.  Is this normal?

One of the manifestations of rheumatoid arthritis outside the joint is the development of rheumatoid nodules.  These occur in just under 10% of patients with rheumatoid arthritis and is one of the more common skin manifestation of rheumatoid arthritis.  They often occur on pressure surfaces e.g. elbow, but can occur elsewhere as well.  For most individuals, they are asymptomatic and specific treatment is not necessary for them.  Steroid injections or surgical removal is sometimes considered, although control of the inflammatory arthritis often improves the nodules too.  Paradoxically, in some patients treated with methotrexate – the gold standard for rheumatoid arthritis treatment – the nodules can worsen, and stopping methotrexate can lead to improvement.



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