Methotrexate is a very useful medication. Rheumatologists would all agree. We use it for rheumatoid arthritis and many other types of autoimmune conditions.
I'm comfortable with it and have hundreds of patients on this medication. Everyday, I spend a proportion of my time looking at Methotrexate-monitoring blood tests for patients using this medication. Every week, I would write a number of prescriptions.
It's also true that I would regularly spend a lot of time allaying patient fears about this drug.
Why?
Bad press. And misinformation. Lots of it.
Methotrexate has been used as chemotherapy at much, much higher doses and in different formulations than those used in arthritis. This leaves it with a stain. A little knowledge is a dangerous thing and many friends, family members, well-wishing members of the community, and even, some health professionals are guilty of scaremongering.
When rheumatologists use Methotrexate in the context of arthritis, it is NOT chemotherapy. It's an arthritis drug.
In fact, the doses we use, which are much lower, with the medication used once weekly only, and orally in the majority, are typically well-tolerated.
I am not saying that Methotrexate should not be used with caution or that it's side-effect free.
Every medication has POTENTIAL side effects. As doctors. we would prescribe a medication if the potential benefits of the medication outweigh the potential risks of that medication.
We also monitor the patient's clinical state as well as blood tests closely to ensure safety. Side effects if they develop can be dealt with quickly and if necessary, the dose is reduced or the medication ceased. All it takes is good communication between patient and rheumatologist.
I write this post because of the many patients who are dissuaded from taking Methotrexate due to some scary thing they've read or been told about.
Typically, if your rheumatologist has suggested Methotrexate, there's a good reason. In the case of rheumatoid arthritis, it's because rheumatoid arthritis is a serious disease with many bad consequences when it's not treated adequately. Methotrexate is the initial, go-to drug in most cases.
What stories about Methotrexate have you heard?