Methotrexate in rheumatoid arthritis

Response to treatment cannot be expected before 2 months and may not occur until after 6 months treatment.

• increasingly popular drug for this condition in the USA
• once weekly dose
• long term tolerability is better than that of gold, sulphasalazine, or penicillamine.
• disease suppression starts earlier that with other slow-acting antirheumatics and patients are less likely to stop treatment
• toxic effects include:
  • pneumonitis in 3% of patients
  • bone marrow suppression in approximately 3%
  • opportunistic infections
  • accelerated nodulosis of the hands
  • cirrhosis and liver failure - very rarely
• overall side-effects are less common and can be minimised by folic acid supplementation

Reference:

1. Porter DR. Medical management of rheumatoid arthritis. BMJ 1993; 307:425-428.
2. Drug and Therapeutics Bulletin (1995). Methotrexate and rheumatoid arthritis. 33(3):17-19.
3. Current Problems in Pharmacovigilance 2000; 26: 10.