Methotrexate intolerance in rheumatoid arthritis Save
Methotrexate (MTX) is the most commonly used DMARD in rheumatoid arthritis (RA); however, there is significant intolerance to this drug among adult RA patients - especially at doses above 15 mg per week.
A cross- sectional, single center study from India included RA patients on regular oral or subcutaneous MTX for a lease three months. Patients were surveyed using the methotrexate intolerance severity score (MISS) questionnaire. Patients with a MISS score ≥ 6 were considered MTX intolerant. Intolerance was correlated with clinical variables and disease activity (DAS-28 CRP).
Among a total of 200 adult RA patients (86% female), the average duration of MTX use was 46 months.
- MTX intolerance was observed in nearly 35% - Nausea (85.5%) and GI discomfort (59.42%) were the most prevalent symptoms.
- nausea was a predominant symptom not only after MTX administration but also as an anticipatory and associative symptom
- MTX intolerance was correlated with female gender, disease severity, and MTX dose. 42-48% were MTX intolerant with the DAS28-CRP > 3.2
MTX doses of 15 mg/week or greater may be associated with intolerance.
This study did not evaluate the effects of folate supplementation on intolerance.
Join The Discussion
I am not surprised at the relative high incidence of GI side-effects, particularly when the Methotrexate dose exceeds 15mg/week. I have seen rheumatologists indiscriminately go for higher doses of Methotrexate right from the beginning. Studies on the use of Methotrexate in combination with an TNF-alpha inhibitor such as Adalimumab showed good efficacy with doses less than 15mg/week.
Disclosures
The author has no conflicts of interest to disclose related to this subject
If you are a health practitioner, you may Login/Register to comment.
Due to the nature of these comment forums, only health practitioners are allowed to comment at this time.