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Methotrexate in rheumatoid arthritis

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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.

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