Methotrexate

Methotrexate

Methotrexate is used for a variety of disorders. While it is used to treat some types of cancer, in lower doses, it is used to treat autoimmune diseases. 

 

For autoimmune diseases, methotrexate may be taken orally or as an intramuscular injection. The normal dose for rheumatoid arthritis is 7.5mg per week. It may be given in one dose or in divided doses.

Some patients have side effects to oral methotrexate that can be decreased by switching to the injectable form.

Before you start methotrexate, your physician will do routine lab tests to check blood counts and to ensure your liver is healthy enough for the medication. Tell your physician if you are an alcoholic, have liver or kidney disease, stomach ulcers, or an infection.

It's very important that you provide your physician with a list of all the medications, even over the counter medicines, that you are taking. Your doctor also needs to know about any other types of treatments you may be taking - like radiation therapy.

Methotrexate can cause birth defects in a baby when taken by the mother or father. Don't use it if you (or your wife) are pregnant or planning to become pregnant. Notify your physician as soon as you suspect that you might be pregnant if you are on therapy.

Side effects can include serious, life threatening side effects.

Call 9-1-1 if you experience the following:

• Swelling of the mouth, throat, tongue or other signs of severe allergic reaction

If you experience any of the following, call your physician right away:

• Very dark urine or blood in your urine
• Vomiting coffee ground or bloody emesis
• Bloody, black, or tarry stools
• Diarrhea
• Changes in vision
• Confusion
• Seizures
• Coughing
• Swelling of legs or feet
• Red dots on the skin
• Shortness of breath
• Any unexpected bleeding or bruising
• Sores in mouth and lips - can lead to dehydration if it interferes with drinking
• Back pain
• Signs of infection - fever, cough, chills
• Dizziness
• Drowsiness
• Headache
• Painful or difficult urination
• Unusual tiredness or weakness
• Yellow discoloration of the skin or eyes

Common side effects:

• Loss of appetite
• Nausea and vomiting
• Acne
• Boils
• Skin Rash or Itching
• Hair loss

It is important to avoid alcohol while taking methotrexate due to the increased risk of liver damage. Also, be sure to keep your follow-up appointments with your physician, including those for lab work only.

Routine labs are needed to monitor liver function and to ensure your blood counts are adequate to continue the medicine.

For more information on rheumatology, visit the International Foundation for Autoimmune Arthritis.

1. Drugs .com
2. Harrison's Rheumatology 2nd Edition - Anthony S. Fauci, MD - Editor

 

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Psoriatic Arthritis

Psoriatic arthritis falls into the category of inflammatory arthritis, yet this disease is not as well known as some of the other autoimmune diseases.

It's usually occurs in people with psoriasis, but about ten percent of the time, the arthritis shows up first, then the psoriasis. PsA is usually sero-negative and it affects joints of the fingers, including the DIP joints, and the spine and sacroiliac joints.

PsA usually follows psoriasis - 60% to 70% of the time, but 15% to 20% of the time the PsA and the psoriasis appear within one year of each other. In only about 15% to 20% of cases does the arthritis present first.

When the arthritis presents first, it can create problems in diagnosis. Often patients are diagnosed with inflammatory polyarthritis or sero-negative RA.

There are no lab tests to diagnose PsA, but sometimes patient have a low positive RA titer or ANA. Often the CRP and Sed Rate are also elevated. If the patient has severe psoriasis, the uric acid levels may also be elevated.

On x-ray the damage caused by PsA looks different than the damage caused by RA, but the disease can still cause severe damage, so early treatment is important.

Treatment can resemble the treatment of RA. Methotrexate, Arava, and TNF inhibitors are used to treat the disease and prevent progression.

Early and aggressive treatment is important to prevent many of the deformities associated with PsA. If you believe you could have PsA, it is important to discuss this with your physician.

1. Harrison's Rheumatology - 2nd Edition; Editor Anthony S. Fauci

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It's time to REGISTER for FREE to attend World Autoimmune Arthritis Day's 2013 Virtual Convention!

 

http://worldautoimmunearthritisday.org/expo/

 

You can also tweet about it: Register now 4FREE! WorldAutoimmuneArthritisDay #WAAD13 5.20.13-LIVE chats/Experts/36Nonprofits! www.WorldAutoimmuneArthritisDay.org/expo/

 

Some background detail for you:  World Autoimmune Arthritis Day is an annual 47-hour event where nonprofits, advocates, and experts from around the world unite in order to provide educational and awareness information to patients, their supporters, and the general public.  This years event aims to triple in size from 2012, adding Nonprofit Booths, Vendors, a Raffle and a special feature: A Day in the Life with Autoimmune Arthritis (an Apple/Android app and Exhibit Booth).

 

WAAD13 begins at midnight of the first World Time Zone and ends at 11:59 of the last World Time Zone, or 6am ET/USA May 19th and ends at 5am ET/USA May 21st, 2013. It is an interactive, LIVE, Virtual Convention that you can attend for FREE...just find an internet connection and join the rest of the world for 47 hours of education and fun!

 

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Funny Gimp Stories

Autoimmune diseases affect all aspects of our lives. Because of the way they affect balance, hand grip, stamina, etc, we all have funny stories to relate.

One of mine comes from when I was a dialysis nurse. I made rounds with the physician and we stopped by a patient's chair. When I stepped back so we could make our way to the next patient's chair, I landed on my rear.

While I had no injuries, other than my pride, the poor patient thought I'd tripped over her feet and every time I went near her, she tucked her feet as far under the chair as she could.

When my co-workers realized I wasn't injured, they all had a good laugh. I wish I could tell you that was the last time I gave them a good laugh....

I fell more times than I can remember. One day, I dropped a twenty-four hour urine jug spilling urine all over the floor... there's a lot of pee in one of those jugs! Not to mention, I had to tell the patient that he had to re-do the test.

I could go on with my klutzy episodes, but I know most of you have some funny stories to share - so please do!

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RA and Lupus Diagnosis Criteria

Lately I've heard some strange stories from friends who were told they couldn't have Lupus or RA for various reason. One friend was told she didn't have Lupus because she didn't have psychosis or seizures. 

With all of the misinformation floating around, I thought I would share the diagnosis criteria for each of these diseases.

Rheumatoid Arthritis:

 At least four of the following criteria must be met in order to diagnose a patient with RA

1. Morning stiffness or stiffness after sitting for a prolonged period that lasts at least one hour and has been present for at least six weeks.
2. Swelling of three or more joints for at least six weeks.
3. At least one swollen area in the wrist, hand, or fingers
4. Symmetrical joint swelling
5. Presence of rheumatoid nodules
6. Abnormal Rheumatoid Factor levels in the blood
7. X-ray changes in the hands - although this is now thought to be evident only in disease progression.

Lupus:

 Any combination of four of the following eleven criteria are a good indication the patient may have Lupus:

1. Rash - fixed redness either flat or raised over the nose and cheeks
2. Discoid rash - red, circular raised patches with scaling, hair follicle plugging and possible scaring.
3. Photosensitivity - exposure to sun or ultraviolet light causes the rash.
4. Oral and nasopharangyeal ulcers
5. Arthritis of two or more joints with tenderness and swelling
6. Pleuritis, pericarditis or serositis
7. Renal disorder with protein >0.5g/d or 3+ cellular casts in urine
8. Neurologic disorder: either seizures or psychosis without other causes
9. Hematologic disorder - either hemolytic anemia, leukopenia, lymphopenia, or thrombocytopenia without a drug-induced cause.
10. Immunologic disorder - Anti-dsDNA, anti-SM, and/or anti-phospholipid
11. Antinuclear antibodies: An abnormal ANA titer in absence of drugs known to induce.

1.  http://www.medicalcriteria.com/criteria/sle.htm
2. http://www.webmd.com/rheumatoid-arthritis/guide/diagnosing-ra

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Faces of Rheumatoid Arthritis

RA can affect any joint and many of the organs. I found this great video and thought I would share it with you. I

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Word Picture

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