Question
I have RA which, until recently has been well controlled with sulphasalzine, Bextra and prednisone when needed. Most recent x-rays show significant erosion in my hands. My Rhumatologist would like me to go on methotrexate at this time. I understand that the use of this drug may cause liver and lung damage. I am debating the pros and cons of going on this drug. Will the use of this drug help slow up the progression of RA significantly enough to take the risk of the possible side effects. Also at this time I do smoke and occassionaly will have a cocktail, what effect do these risk factors have while taking methotrexate?
Answer
Make sure you read the section on methotrexate (Mtx) on this website. Overall, Mtx is very effective and well tolerated. In fact remains the “gold standard” disease modifying agent for RA despite the introduction of the newer, very effective agents such as Remicade, Enbrel and Humira. Liver enzyme (blood test) elevations are found in about 1% to 3% of patients, but these are reversible if the drug is stopped. Liver failure is extremely rare. If patients are on a stable dose of Mtx and have normal liver tests, I allow them to have 1 or 2 alcoholic beverages per week. Lung problems are also very rare, so rare its difficult to give an exact number. I think most rheumatologists have had a few cases, but small by comparison with the many patients on Mtx. You should discuss with your doctor. But in patients with erosions on x-ray, in general, the benefits of Mtx outweigh the risks.
