Methotrexate Side Effects [posted 7/31/98]
Question: My mother has rheumatoid arthritis. Her doctor has put her on methotrexate 2.5 mg 6 tablets weekly. What are the side effects pertaining to cancer and vascular complications? Any other side effects would also be appreciated.

Answer: Methotrexate was initially used to treat different cancers because of its ability to inhibit rapidly dividing cells. It has subsequently been used with great success in diseases such as Rheumatoid Arthritis, Psoriasis, Inflammatory Bowel Disease, etc., to decrease the inflammatory response. However, the toxicity is mainly the same - aimed at cells that divide rapidly. These include white blood cells, platelets, mucosal surfaces (mouth, stomach, intestines), etc. Additional toxicities are liver fibrosis and occasional pulmonary fibrosis. These should be watched in all patients on methotrexate. Lastly, defective sperm and oocyte formation, renal toxicity, alopecia, dermatitis. Long term there is an increase in solid tumors - this looks dose dependent and the doses in RA are pretty small. Vascular complications are pretty minimal.

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