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[Treatment with low dose methotrexate in rheumatoid arthritis: risk factors for severe complications]
J M Berthelot1, J Glemarec, A Chiffoleau
1Service de Rhumatologie, CHU Nantes, France.
Abstract:
Treatment with low dose methotrexate in rheumatoid arthritis is associated with serious side effects in about 5 per cent of cases (respiratory, haematological or infectious). The goal of a null risk seems unrealistic because of the idiosyncrasy of some of the risks and our poor understanding of others (enzymatic polymorphisms might be operational, and infectious agents could act as co-factors). However, risk can be greatly reduced by a careful selection of patients. Some contraindications are strict: poor compliance and the possibility of mistake in the timing of the administration; pregnancy or desire for pregnancy; treatment with trimetoprim; haemodialysis; renal insufficiency (clearance < or = 50 ml/min) (and therefore old age), alcoholism. Others remain relative although well established; hypoalbuminaemia, diabetes mellitus, obesity, past infection with hepatitis virus. Others are dubious: starvation, macrocytosis, surgical stress, NSAIDs. An extensive large study of side effects is warranted.
Insights
Low dose methotrexate for rheumatoid arthritis can cause serious side effects in 5% of patients. Careful patient selection significantly reduces these risks, making treatment safer.
Area of Science:
- Rheumatology
- Clinical Pharmacology
Background:
- Low dose methotrexate is a common treatment for rheumatoid arthritis.
- Serious adverse events (respiratory, hematological, infectious) occur in approximately 5% of patients.
Purpose of the Study:
- To identify patient selection criteria for minimizing methotrexate-related risks.
- To evaluate contraindications for methotrexate therapy in rheumatoid arthritis.
Main Methods:
- Review of known methotrexate side effects and risk factors.
- Categorization of contraindications into strict, relative, and dubious.
Main Results:
- Strict contraindications include poor compliance, pregnancy, trimethoprim use, renal insufficiency, and alcoholism.
- Relative contraindications include hypoalbuminemia, diabetes, obesity, and hepatitis virus infection.
- Dubious risk factors include starvation, macrocytosis, surgical stress, and NSAIDs.
Conclusions:
- While eliminating risk is not feasible, careful patient selection is crucial for methotrexate safety.
- Further large-scale studies are needed to comprehensively assess methotrexate side effects.