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Posted by on Nov 8, 2016 in Rheumatoid Arthritis | 0 comments

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In a nutshell

This study looked at patient-reported side effects associated with methotrexate (Rheumatrex) when taken in tablet form or by injection for rheumatoid arthritis (RA). The authors concluded that there are a number of side effects associated with both forms of methotrexate that may not be recorded during routine treatment.

Some background

Methotrexate is usually the first treatment prescribed for patients with RA. It can effectively reduce swelling that causes pain. Methotrexate can be taken as a tablet or by injection. As with most drug therapies, there are some side effects associated with methotrexate treatment. The most common are gastrointestinal problems such as nausea and diarrhea. Using syringes to inject methotrexate may lead to further side effects such as pain at the site of injection. If side effects become too bothersome or treatment is not effective enough, patients may switch to a biological drug, such as adalimumab (Humira). Patients are often asked to report on particular side effects during their treatment. However, there may be other significant side effects experienced by patients not captured by these standard reports.

Methods & findings

382 patients answered an online survey to report on a number of different side effects associated with their treatment for RA. Of these, 57.1% of patients were treated with biological drugs (most common were adalimumab and etanercept [Enbrel]). 12.8% of patients were receiving methotrexate by injection. 30.1% of patients were treated with methotrexate in tablet form. 
 
24% of patients receiving injectable biological drugs reported pain at the site of injection. In contrast, 18% of patients treated with injectable methotrexate reported pain at the site of injection.
 
Side effects that were significantly more common with treatment involving methotrexate included diarrhea, fatigue, feeling generally unwell, and hair loss. Mental fog (such as confusion, forgetfulness, and lack of focus) was also more severe in both methotrexate groups compared to biological therapy.
 
Patients receiving high doses of methotrexate were 2.26 times more likely to experience a high rate of side effects compared to those receiving low doses. Patients receiving medium doses of methotrexate were 57% more likely to experience a high rate of side effects. 

The bottom line

Authors concluded that there are a number of side effects associated with methotrexate treatment that may be under-reported.

The fine print

Patients were self-reporting side effects and medication use, which may not always be fully accurate.

Published By :

BMC musculoskeletal disorders

Date :

Oct 03, 2016

Original Title :

Patient’s experience with subcutaneous and oral methotrexate for the treatment of rheumatoid arthritis.

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