Side effects of methotrexate therapy in patients with rheumatoid arthritis

Introduction: Methotrexate is widely used as the most common disease-modifying anti-rheumatoid drug (DMARD) and is known as the first line treatment for rheumatoid arthritis (RA). Objectives: To assess the side effects of methotrexate in Iranian patients with RA and to compare them with the known side effects from previous studies. Patients and Methods: We conducted a cross-sectional study of 300 patients who fulfilled the EULAR 2010 criteria of RA. The following data were recruited from patients’ profiles; age, body mass index (BMI), duration of treatment with methotrexate, initiating dose, maximum dose and current dose of methotrexate, history of fatty liver disease or hepatitis B and concomitant use of sulfasalazine, leflunomide or hydroxychloroquine. Results: In 149 out of 300 patients (49.66%), Methotrexate therapy was stopped or tapered due to side effects including nausea (23%), flu-like symptoms (8%), hepatotoxicity (12%) and hair loss (6%). The patients with hepatotoxicity had a higher duration of treatment with methotrexate (10.35 compared with 5.83; P<0.001) and also the higher initiating dose of methotrexate (12.91 compared with 12.17; P=0.010). All of the RASS (rheumatoid arthritis severity scale) indexes including disease activity, functional impairment, and physical damage are related to the presence of hepatotoxicity (P<0.001). Conclusion: Methotrexate is an excellent and effective agent for the treatment of RA and its potential side effects during the treatment are dependent on the methotrexate dosage, the level of anti-citrullinated protein antibody (ACPA) and anti-MCV antibodies and concomitant use of other drugs such as leflunomide.

Vitamin D Deficiency in Rheumatoid Arthritis and Vitamin D Levels that vary with Rheumatoid Arthritis Severity: An Indian Study

ABSTRACT Introduction Rheumatoid arthritis (RA) is an autoimmune disease characterized by periods of remission and flares of symmetrical joint inflammation slowly progressing to joint and cartilage destruction leading to deformities. Evidence is accumulating suggesting vitamin D deficiency and its correlation in autoimmune diseases including RA. Aims of study (1) Estimation of vitamin D levels in RA patients. (2) Correlation of vitamin D levels with severity of the disease. Materials and methods A study population of 50 included 25 cases and 25 controls. Both males and females of 30 to 40 years of age were taken for this study. Patients of RA having any other autoimmune disease were excluded. Twenty-five healthy adults, whose ages were between 30 and 40 years, both male and female, free from any systemic illness were taken as controls. Routine systematic examination and detailed joint examination were done. Disease activity was measured in patients of RA according to Disease Activity Score (DAS-28). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), and anticyclic citrullinated peptide (CCP) among other routine blood investigations were done. Results In cases, the mean vitamin D level was 18.41 ng/mL with standard deviation (SD) of 7.10, while controls had mean level as 22.32 ng/mL with SD as 4.80. The difference between the two was recorded as statistically significant, i.e., p-value <0.05. While 4 (16.0%) patients had low severity, 15 (60.0%) had moderate severity, and 6 (24.0%) patients had high severity of disease as per DAS-28. Patients whose RA disease activity was high had lower vitamin D levels. Conclusion It is thus concluded that in RA patients the serum vitamin D levels are significantly lower than in healthy control, and vitamin D deficiency may be one of the causes contributing to worsening of RA. How to cite this article Latief M, Abbas F, Minhas A, Dar W, Parry M, Gupta PD. Vitamin D Deficiency in Rheumatoid Arthritis and Vitamin D Levels that vary with Rheumatoid Arthritis Severity: An Indian Study. J Postgrad Med Edu Res 2017;51(4):162-165.