If you review medication interactions for methotrexate, the list appears long, but in fact, is not entirely accurate. There are many medications listed that you should not take with methotrexate, but most of them are only theoretical, whereas we have years of experience knowing these combinations are in fact safe.

It is very common to use methotrexate and sulfasalazine together, and it is considered safe. Similarly, some texts suggest methotrexate should not be used with anti-inflammatories (NSAIDs) or stomach protector medications called proton pump inhibitors (PPIs). Again, these combinations are used frequently. In fact, it is not uncommon that some arthritis patients are on methotrexate, sulfasalazine, ibuprofen and omeprazole (a PPI) all at the same time.

We do recommend holding methotrexate if you require a sulfa-based or penicillin-based antibiotic, but these are really the only interactions we watch for.

Many people are asking: I have rheumatoid arthritis. Will I be able to get the COVID-19 vaccine when it becomes available?

As we answer this (Dec/2020), we do not fully know the answer yet. It is a complicated question as it relates to both the safety of the vaccine, and how well it works. Safety is really the key part, and because the technology being used to develop the COVID19 vaccines is mostly new, we do not have the experience to know for sure if it’s safe. That said, there is currently no reason to think it won’t be safe, as they are not LIVE vaccines, which are contraindicated for many individuals with arthritis because of the medications they are on. As we get closer to having vaccine available, we expect more data to also come out which will help inform this decision. Stay tuned as we learn more, and check with your rheumatologist for your particular situation.

Click here to visit our COVID-19 vaccine information page, which we will keep up to date, or our YouTube site with COVID-19 information videos.

Jonathan from Calgary asks: Is there any specific advice recommended for rheumatology patients and COVID-19?

Please click here to our page on COVID-19. We will try to keep this information up to date, but the situation remains fluid.

Bazgha from Fort McMurray asks: My wife has rheumatoid arthritis; she has pain in her hand joints. What kind of exercise would you recommend to ease the pain and stop the condition from getting worse.

Exercise is good for the body and similarly, good for joints. Keeping muscles strong around joints may help reduce pain and will help maintain function. Weaker muscles may lead to more pain and less ability to do day to day activities. Of course, everyone should always listen to their bodies – whether or not they have arthritis – so as not to over do it. If it is starting to hurt too much, take a break.

Shannon from Strome asks: Would you recommend the practice of yoga for inflammatory arthritis patients? Would you share benefits of a regular yoga practice and any cautions or concerns you may have?

While there are studies looking at the potential benefits of yoga for individuals with inflammatory arthritis, they are limited. That said, the results that have been published appear encouraging, with improvement in pain and quality of life. The risks of yoga, as would be the case for most forms of exercise, are small. It is generally considered quite safe. Just like someone who does not have arthritis, if something hurts, you listen to your body and stop. However, yoga should not make the arthritis itself worse and has many potential benefits to those who participate.

Alyssa from Edmonton asks: What type of inflammatory arthritis occurs in multiple joints and yet shows negative on blood tests for the RA factor?

In many cases, inflammatory arthritis is a clinical diagnosis, meaning it can be diagnosed by listening to the patient’s story and performing an appropriate physical examination. Rheumatoid arthritis can be associated with a number of positive blood tests, including a rheumatoid factor or anti-CCP-antibody, but a negative test does not exclude the diagnosis. Other forms of inflammatory arthritis that usually have negative blood tests include psoriatic arthritis, enteropathic arthritis, and reactive arthritis.

Caroline from Scotland asks: Does Ankylosing Spondylitis affect joints besides the back?

While Ankylosing Spondylitis usually affects the back, it can affect other joints as well. Larger joint involvement is more common than smaller joints such as the hands or feet. Tendon involvement, particularly where the tendon attaches to the bone, can be seen.

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.

Linda from Canada asks: My rheumatoid arthritis doctor mentioned that I have erosions. Could you please explain this…how serious is it? Is there something one can do for it?

Rheumatoid arthritis causes joint pain, stiffness, swelling, functional impairment, and if not controlled quickly enough, it can cause permanent damage to the joint. The first sign of permanent damage is an erosion, a small bite out of the bone about the joint. A small bite of the bone is not something that a person will notice, but if it continues to develop bigger and there are more of them, it can cause significant deformity in the future. Once an erosion occurs, it cannot be reversed. However, aggressive treatment to control rheumatoid arthritis can prevent further damage from happening.

Daniel from Edmonton asks: My friend has psoriatic arthritis. He is in a lot of pain and is getting treatment to help deal with his condition. One thing he would like to do is start a fitness routine to help. I’m looking for advice on how to help plan and work in a fitness routine that could account for his joint pain.

Great question! We encourage our patients with inflammatory arthritis to stay active despite having arthritis. We know that maintaining activity and muscle strength is a positive, and can be an important component of treatment and well being. Further, activity itself should not make the arthritis worse. That said, every individual is different and we need to ensure an appropriate balance between remaining active and not causing pain. Physical therapists with expertise in inflammatory arthritis are often involved in consulting and developing activity plans. Your rheumatologist should be able to recommend an appropriate physical therapist to you.