Methotrexate myths and facts

fact or myth fiction trueIf you’ve just been diagnosed with rheumatoid arthritis (RA), the first treatment your rheumatologist often prescribes for you is methotrexate. This disease-modifying antirheumatic drug, or DMARD, is the first line of defense against the inflammation, pain and joint damage of RA.

You may have heard different things about methotrexate, because it’s a drug that many people have used for years to get RA inflammation under control. Here, we separate the myths from the facts about methotrexate so you can get the most from your treatment, use it safely, and help prevent side effects.

Remember: Always take your methotrexate as your doctor prescribes. Ask your rheumatologist, nurses, or pharmacist if you have questions about how to take this or any drug for your arthritis.

MYTH: I’ll only have to take methotrexate until my inflammation is under control. If I go into remission, I can stop taking methotrexate for good.

FACT: Methotrexate helps control your inflammation. So you may feel much better than you did before you started methotrexate: less pain, swelling, morning stiffness or fatigue. That’s not the same as remission, which is based on your blood tests and joint counts. Even if your RA goes into remission, your rheumatologist may want you to keep taking methotrexate, possibly at a lower dosage or less frequently than you do when your RA is active. You don’t want to risk a painful flare or your disease becoming active again.

MYTH: Methotrexate can cure my RA.

FACT: At this time, there’s no cure for RA. Methotrexate is the first line of treatment for most people with active disease, and it can help you get your inflammation under control so you feel much better. Your treatment goal is to get your RA into remission – but that’s not the same as a cure. Methotrexate can help you lower your disease activity – measured with various tests your rheumatologist will give you – but it can’t “cure” your RA.

MYTH: Methotrexate is bad for my liver. If I take it too long, I could get liver disease or cancer.

FACT: Methotrexate could be harmful to your liver or kidneys, so your rheumatologist will watch your liver and kidney function carefully as you take your drug. You’ll need to have regular blood tests just to make sure that methotrexate isn’t causing harm – and take other steps to protect your liver’s health, like not drinking alcohol. But taking methotrexate doesn’t mean you will necessarily develop liver diseases like cirrhosis or liver cancer (HCC).

MYTH: If I take methotrexate, it means I can’t ever have children.

FACT: Methotrexate, like many other drugs, can cause serious birth defects, including fetal death. So you absolutely should not get pregnant or father a child while you’re taking methotrexate. You also shouldn’t breastfeed while you’re taking this drug. But you can work with your rheumatologist to go off methotrexate for a period of time to clear it from your system – and then conceive a baby once your rheumatologist says it’s OK to proceed.

Methotrexate has many unpleasant side effects, like nausea or vomiting. It may even make my hair fall out. There’s nothing I can do about these side effects – so it’s just a case of “grin and bear it.”

FACT: Some people who take methotrexate do experience unpleasant side effects, including nausea, vomiting, mouth sores, rash, diarrhea, coughing, sun sensitivity or mild hair loss. The good news is that not everyone experiences all of most of these side effects, and many people find them to be mild. Better news: There are a lot of things you can do to ease or prevent methotrexate side effects. Your doctor may be able to adjust your dosage, or switch you to subcutaneous shots of methotrexate instead of pills, which may be easier on your stomach.

You can also take folic acid supplements, which you can buy over the counter, along with methotrexate. These B vitamins help most people greatly reduce side effects like mouth sores, sun sensitivity, hair loss and stomach upset.

There you have it, some of the biggest methotrexate myths explained.

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