Methotrexate – The RA Drug Many Love to Hate
Methotrexate (MTX) is often one of the first disease modifying (DMARD) medications that is prescribed for RA patients. This is because it is generally effective in slowing the disease processes and is relatively inexpensive. It works by impacting the overactive immune system involved in RA.1
Methotrexate is a chemotherapy drug developed in the 1950s2 and is still used to treat forms of leukemia, breast cancer, lung cancer, non-Hodgkin lymphoma, and head and neck cancers (see American Cancer Society). It stops the growth of cancer cells by affecting their metabolism. Given the immunosuppressing nature of methotrexate, it is now commonly used in lower doses to treat various autoimmune diseases including rheumatoid arthritis and psoriatic arthritis. It’s also used to treat tubal ectopic pregnancies by inducing abortion.3 In spite of the low doses used in treating RA, some of the chemotherapy side effects remain including hair loss and nausea.4 This paints a picture of a rather toxic medicine!
A study of how patients respond to the side effects of methotrexate was recently published.5 Patients were given a survey called the methotrexate intolerance severity score (MISS) that measures four areas of side effects – abdominal pain, nausea, vomiting, and behavioral symptoms (restlessness, irritability, refusal to take). Over 43% of patients reported some sort of gastrointestinal side effect with nausea being the most common. Behavioral symptoms were seen in over 16% of patients. Intolerance levels were reported at 11% with these patients not able to take the drug due to side effects. These results demonstrate that many people struggle with taking MTX. However, folic acid and leucovorin (folinic acid) are B vitamins that can be used to counteract the side effects and most patients will take one of these along with MTX.6
When first diagnosed with RA, I was prescribed oral methotrexate. After a month of taking the pills, I felt terrible and was basically non-functional. It felt like a truck ran over me as I had no energy, felt sick at my stomach non-stop, and had headaches. The RA symptoms were bad enough but this just added insult to injury. My rheumatologist finally told me that I clearly could not tolerate the drug and to stop taking it. Several years later, and with a different rheumatologist, I asked about taking MTX injections because I was desperately trying to find a treatment combination that worked. It was recommended to add MTX with the biological medicines I was taking as the combination of the two typically produces better results. I started take methotrexate via weekly self-injection and found that the nausea side effects were much less than with oral pills. I tolerated the MTX much better when injecting it. The process is really not that bad if you use small needles in syringes designed for insulin injections.
In spite of the various side effects and scary thoughts about taking a chemotherapy drug, most RA patients are greatly benefited and seem to tolerate MTX rather well. Try using folic acid or injecting it if the side effects are bothersome. It’s much better to take a DMARD like methotrexate in order to combat the long-term impacts of the disease rather than avoid it because of side effects that may be able to be managed.
Only your doctor can prescribe prescription medicines for you. Do not stop taking any medicine without speaking to your doctor. If you experience new or different symptoms or side effects while taking methotrexate, please make sure you discuss them with your doctor immediately.
On a scale of 1(low) to 5(high), how difficult is it for you to talk about having RA?