Methotrexate for rheumatoid arthritis
Content:
- Features of rheumatoid arthritis
- Why is methotrexate good?
- Frequency while taking methotrexate
- special instructions
Features of rheumatoid arthritis
In rheumatoid arthritis, paired joints are usually affected, for example:
- Elbow;
- Knee;
- Wrist.
But the insidiousness of this disease lies in the fact that a total defeat of certain internal organs can be observed. We are talking about the lungs, heart, eyes, blood, the skin can also be affected. But most often this ailment affects the joints in the arms.
Another feature of the disease is that rheumatoid arthritis most often occurs in females. However, it is more severe in men. It is also noteworthy that the disease manifests itself in 80% of cases in people over 35, although it can affect the elderly and children.
The main treatment for RA should be considered drugs belonging to the group of "basic drugs".
Why is methotrexate good?
For the treatment of rheumatoid arthritis, it is optimal to use just such a remedy as methotrexate. This drug has antitumor and cytostatic effects. It belongs to the group of antimetabolites that inhibit dihydrofolate reductase and take part in the process of converting dihydrofolic acid to tetrahydrophalic acid.
More importantly in rheumatoid arthritis, methotrexate inhibits DNA synthesis, DNA repair, and cellular mitosis.
Rapidly growing tissues are especially sensitive to this process:
- Tumor cells of a malignant type;
- Bone marrow;
- Embryonic;
- Epithelial cells of the intestinal mucosa;
- Bladder;
- Oral cavity.
Together with the antitumor effect, methotrexate also has an immunosuppressive effect.
There is no single instruction for the use of methotrexate. You can only decide on the general scheme of its use, because there are no definite strict dosages for the treatment of RA.
Methotrexate can be taken as a pill or special injection. The dosage size can be different: from 6.5 mg to 26 mg. As a rule, the minimum dose is first prescribed, then after two to three weeks it is increased. And so on until a sufficient clinical effect is achieved (or the phenomenon of drug intolerance does not appear).
Further, in the process of treating rheumatoid arthritis, they adhere to the verified dosage, and in the overwhelming majority of cases, the drug is taken once every seven days. In some cases, experts prescribe the reception of Methotrexate fractionally, that is, divide one dosage into two, three or even more doses. They should be performed with a time gap of at least 12 hours.
In 70% of cases, the maximum possible effect is not achieved very quickly. We are talking about a period of six months from the beginning of the drug intake and the establishment of the final dose. Primary positive changes become noticeable after five to six weeks.
Frequency while taking methotrexate
Control over the frequency of drug intake should be considered a fundamental condition for the successful treatment of RA.
It happens this way:
- A certain day is selected when it will be necessary to take the drug (for example, Monday);
- Throughout the subsequent treatment, the drug will be taken on the specified day of the week.
In addition, on the day when methotrexate is taken, experts recommend dispensing with those drugs that relieve inflammation. On other days, NSAIDs can be used.
It is important to remember that even with rheumatoid arthritis, in certain cases, using methotrexate is simply unacceptable. We are talking about infectious diseases, ulcers of the oral cavity and gastrointestinal tract, underwent operations in the last six months, gout or renal calculi in the history of the disease, because there is a high risk of hyperuricemia. It is also forbidden to use this drug in old and childhood.
It is recommended to avoid the use of alcohol and those medications that have hepatotoxicity. This is necessary due to the fact that their use during treatment with methotrexate greatly increases the risk of liver dysfunction. It is also recommended to avoid prolonged exposure to the sun. When implementing mixed treatment, it is desirable to use each of the drugs strictly at the specified time. If methotrexate is missed, the drug is not taken and the dose is not doubled. This is fraught with severe complications.
During the treatment of rheumatoid arthritis with methotrexate, it is undesirable to vaccinate with viral injections, it is necessary to avoid contact with those who have received a vaccine against a disease such as poliomyelitis, as well as those who are infected with all kinds of bacterial infections.
special instructions
Methotrexate as a lyophilized powder is unsuitable for intrathecal administration in rheumatoid arthritis due to the presence of preservatives.
It is recommended to avoid conception throughout the treatment with methotrexate and after the end of the course. For men, this period is about three months after completion of treatment, for women, at least one ovulation cycle. After completing the treatment course with this drug for rheumatoid arthritis, experts strongly recommend the use of calcium folinate to reduce the effects of high toxic dosages of the drug.
It is also important to follow the indicated rules for the use and disposal of expired methotrexate, both in the form of tablets and in the form of injections, intended for the treatment of rheumatoid arthritis.
See also: All modern treatments for rheumatoid arthritis
Author of the article: Kaplan Alexander Sergeevich | Orthopedist
Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.
