Related Experiment Video

Updated: Apr 13, 2026

Preliminary Study on Acupuncture Combined with Grain-sized Moxibustion for Treating Rheumatoid Arthritis with Finger Joint Pain
04:50

Preliminary Study on Acupuncture Combined with Grain-sized Moxibustion for Treating Rheumatoid Arthritis with Finger Joint Pain

Published on: May 16, 2025

1.4K

Factors associated with methotrexate-related gastrointestinal intolerance and toxicity in rheumatoid arthritis and

Carla Campinho Ferreira1, Inês Borges2, Mariana Pinheiro1

  • 1Unidade Local de Saúde de Braga.

ARP Rheumatology
|April 12, 2026
PubMed
Abstract

Insights

Gastrointestinal adverse events (GIAE) from methotrexate (MTX) are common in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Diabetes, female sex, and psoriatic arthritis predict GIAE, guiding personalized treatment strategies.

Area of Science:

  • Rheumatology
  • Pharmacology
  • Clinical Medicine

Background:

  • Methotrexate (MTX) is a primary treatment for rheumatoid arthritis (RA) and psoriatic arthritis (PsA).
  • Gastrointestinal adverse events (GIAE) are a significant cause of MTX treatment modification and discontinuation.
  • Identifying baseline predictors of MTX-related GIAE is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To identify clinical and laboratory predictors of MTX-related GIAE.
  • To compare the risk profiles of GIAE between RA and PsA patients.
  • To inform personalized MTX treatment strategies.

Main Methods:

  • Retrospective observational study of MTX-treated RA and PsA patients.
  • Data extraction included demographics, comorbidities, laboratory results, MTX details, and medications.
  • Statistical analyses involved univariate and multivariable logistic regression; Kaplan-Meier curves assessed treatment survival.

Main Results:

  • Over half (50.9%) of patients experienced GIAE. Key predictors for GIAE included diabetes mellitus, female sex, and PsA.
  • GI intolerance was linked to higher baseline alanine transaminase (ALT), leflunomide use, and female sex.
  • GI toxicity predictors were diabetes, alcohol consumption, and baseline ALT.
  • Subcutaneous MTX formulation was associated with earlier GIAE.

Conclusions:

  • MTX-related GIAE are frequently associated with metabolic comorbidities, lifestyle factors, sex, and baseline ALT levels.
  • These routinely available parameters can identify high-risk patients early.
  • Personalized MTX initiation and monitoring can be guided by these predictors to improve treatment safety and persistence.

More Related Videos

Author Spotlight: Genetic Profiling for Fluorouracil Response in Gastric Cancer06:21

Author Spotlight: Genetic Profiling for Fluorouracil Response in Gastric Cancer

Published on: May 10, 2024

1.4K
An Adoptive Transfer Model of Rheumatoid Arthritis in Mice07:37

An Adoptive Transfer Model of Rheumatoid Arthritis in Mice

Published on: June 6, 2025

1.5K

Related Concept Videos

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents01:29

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents

Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
712
Drug Toxicity: Risk factors01:24

Drug Toxicity: Risk factors

Adverse Drug Reactions (ADRs) are potential complications that arise during pharmacotherapy, influenced by multiple risk factors. Age plays a significant role; both neonates and the elderly are at heightened risk due to their respective immature and diminished metabolic and elimination processes. Gender also impacts ADRs, with females experiencing a 1.5 to 1.7-fold greater risk than males, which may be linked to pharmacokinetic, pharmacodynamic, and hormonal differences. Notably, neonates, the...
209
Factors Influencing Drug Absorption: Disease States and Pharmacology01:25

Factors Influencing Drug Absorption: Disease States and Pharmacology

Multiple disease states can significantly influence the oral drug absorption process by affecting blood flow and the functionality of the gastrointestinal (GI) system. Various GI diseases, including conditions that alter GI motility, such as diarrhea, decreased acid secretions (achlorhydria), and infections, have been associated with reduced drug absorption.
Substances such as alcohol and specific drugs, including antineoplastics, can also negatively impact drug absorption. For instance,...
1.9K
Therapeutic Drug Monitoring: Affecting Factors01:29

Therapeutic Drug Monitoring: Affecting Factors

Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient's blood or body tissues to manage and optimize therapy. TDM is crucial for drugs with narrow therapeutic windows, like warfarin and phenytoin, where incorrect doses can lead to treatment failure or severe side effects. This monitoring ensures the dosage administered is within a safe and effective range. The factors affecting therapeutic drug monitoring include:Patient-Specific Factors:a.
371
Pharmacogenetics of Phase II Enzymes: N-acetyltransferase, Thiopurine S-methyltransferase, UDP-glucuronosyltransferase01:27

Pharmacogenetics of Phase II Enzymes: N-acetyltransferase, Thiopurine S-methyltransferase, UDP-glucuronosyltransferase

Phase II biotransformation reactions are essential for detoxifying and eliminating xenobiotics, including many pharmaceutical compounds. These reactions typically involve conjugation, the covalent attachment of polar endogenous groups such as glucuronic acid, sulfate, methyl, or acetyl moieties to functional groups introduced during Phase I metabolism. The resulting conjugates are more water-soluble, enabling efficient renal or biliary excretion.The major classes of Phase II enzymes include...
74
Drugs for Treatment of Ulcerative Colitis in IBD01:29

Drugs for Treatment of Ulcerative Colitis in IBD

Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide...
667