The Young and the RA

Methotrexate is one of the most common drugs used to treat RA. But how many of us really know how it works?

“Methotrexate is classified as an antimetabolite drug which means it is capable of blocking the metabolism of cells. (Metabolism consists of the production and destruction of important components of the cell as well as the production of energy for use by the cell.) As a result of this effect, it has been found helpful in treating certain diseases associated with abnormally rapid cell growth” (MedicineNet).

What does this mean, then? It means it keeps cells from growing rapidly which can be helpful in treating diseases such as cancer — where abnormal cells grow out of control — or RA. In RA, methotrexate suppresses the immune system, which in autoimmune disease such as RA keeps the immune system from going out of control and producing too many white blood cells. In RA, the white blood cells of the immune system are attacking the body tissue, typically in the joints but can be in other organs as well. (Yes, people can get RA in the heart! How scary is that?) This causes the swelling, joint pain and erosion of the joints in RA. Methorexate works by suppressing the production of white blood cells (aka fast producing cells), thus preventing the joint swelling in RA since there are not many white blood cells to attack the joint tissue.

 Are you tracking so far? A lot to digest, I know. Keep with me!

Ok, so far we know how methotrexate works and how it affects RA. But what are the side effects? According to drugs.com:

“Stop using methotrexate and call your doctor at once if you have any of these serious side effects:

• dry cough, shortness of breath;
• diarrhea, vomiting, white patches or sores inside your mouth or on your lips;
• blood in your urine or stools;
• urinating less than usual or not at all;
• fever, chills, body aches, flu symptoms;
• sore throat and headache with a severe blistering, peeling, and red skin rash;
• pale skin, easy bruising or bleeding, weakness; or
• nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
• Less serious side effects may include:
• nausea, vomiting, upset stomach;
• dizziness, tired feeling;
• headache;
• bleeding of your gums; or
• blurred vision.”

When I was on 15 mg of methotrexate, I had a bad time with the side effects. I lost hair, experienced fatigue (love how that is the side effect for a lot of RA drugs…) and had headaches. Because of the side effects, my doctors reduced my dose to 7.5 mg, and at my last visit, my doctor suggested we might lower it again in the spring. (Yay!) I now have a lot less problems with the side effects — and more hair!!! But I did meet a woman once, back in my acne-prone days on prednisone, at a dermatologist’s office. She told me that she had been put on methotrexate a few years ago when she had been diagnosed with a mild case of RA. It had caused her to turn yellow, which led her to be taken of the drug. (She now uses exercise and yoga to keep her RA under control, but as I said in yesterday’s post, this isn’t always a good idea! Erosion can occur even if you don’t feel any symptoms.)

One of the big problems with methotrexate is its effect on the liver. You have to have your blood tested every few months, and you can’t really drink on it — only a drink a month. (Total bummer, I know, but your health is worth it, right?) The blood work is kind of a pain, especially if you are like me and don’t give up blood easily (my veins are microscopic, and it takes about three or more times to get the vials they need out of me). But combined with Humira and Imuran, it has left me feeling fantastic! So, if you haven’t checked out methotrexate yet, talk to your rheumatologist! It may help you as much as it has helped me.

Until next time,

S.P.