Question
In 2002 arava was being petitioned to be taken off the market because of severe liver problems. Have there been new studies about it’s safety? My rheumatologist started me on Arava 3 months ago, after plaquinil didn’t work. We didn’t discuss trying methotrexate first. Now that I’ve stumbled onto this info , I’m worried! I’m 41 with inflamation in hand, feet, and knee joints but have never been in severe pain since I was diagnosed a year ago. My mother has severe RA and has been on arava for 5 years after methotrexate stopped working for her. Should I ask to at least try methotrexate first?
Answer
Fortunately, liver failure is an extremely rare complication of Arava therapy with only a handful of cases reported. I am not aware of any new studies. The incidence of liver test abnormalities in the clnical trials is similar between Arava and methotrexate. There is no right answer to your “try methotrexate first” question. Most rheumatologists do start methotrexate first. You might discuss this with your doctor as he/she might have a good reason for choosing Arava first. Both are effective and well tolerated.
