Arthritis Drug has Dizzying Side Effects

Rheumatoid arthritis and psoriatic arthritis patients may have methotrexate intolerance within one year

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Despite decades of use, methotrexate (sold as Rheumatrex and Trexall) remains a first-choice drug for treating conditions like rheumatoid arthritis. But some side effects lead patients to stop taking the drug.

Rheumatoid arthritis and psoriatic arthritis patients may develop gastric intolerance to methotrexate (negative side effects in the stomach and intestines).

Intolerance usually happens within the first year of treatment, making long-term methotrexate treatment difficult.

"Ask your doctor about the risks of your arthritis drugs."

"Methotrexate is one of the most commonly used agents for the treatment of several inflammatory rheumatic diseases, and remains a first-choice treatment for rheumatoid arthritis and psoriatic arthritis with low weekly doses," write Dr. Ediz Dalkilic, of Uludag University in Turkey, and colleagues.

"Major drawbacks of methotrexate treatment that limit its continued use include nausea, vomiting and drowsiness," they wrote.

Past research has found that these side effects have caused anywhere from 20 to 65 percent of patients to stop taking methotrexate.

In their study, Dr. Dalkilic and colleagues found that 28.5 percent of rheumatoid arthritis and psoriatic arthritis patients stopped taking methotrexate within two years due to nausea before taking the drug, or nausea, vomiting and drowsiness after taking the drug.

More than half of these patients stopped taking methotrexate within the first three months of treatment.

Gender, age, diagnosis and rheumatoid factor (RF) positivity (presence of antibody involved in rheumatoid arthritis) did not play a role in patients stopping methotrexate treatment.

These findings applied to patients taking oral methotrexate. When patients switched to a non-oral form of the drug, they were able to tolerate it without these side effects.

The authors concluded that these gastrointestinal side effects present a major obstacle to long-term treatment in patients with rheumatic diseases like rheumatoid arthritis and psoriatic arthritis. However, non-oral methotrexate seems to be a good substitute for those who cannot handle oral methotrexate.

A total of 420 people undergoing methotrexate treatment were involved in the study. Of these, 346 were being treated for rheumatoid arthritis and 74 were being treated for psoriatic arthritis.

The research is published in the journal Modern Rheumatology.

Reviewed by: 
Review Date: 
July 23, 2012
Last Updated:
February 16, 2013