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Submitted: 04 Feb 2021
Accepted: 23 Apr 2021
ePublished: 19 Jun 2021
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Immunopathol Persa. 2021;7(2): e38.
doi: 10.34172/ipp.2021.38
  Abstract View: 238
  PDF Download: 84

Original

Side effects of methotrexate therapy in patients with rheumatoid arthritis

Maryam Masoumi 1 * ORCID logo, Javad Balasi 2 ORCID logo, Seyed Mahdi Aghamiri 3 ORCID logo, Soroush Moradi 4 ORCID logo, Mahbube Baghban 5 ORCID logo, Mostafa Vahedian 6 ORCID logo, Alireza Gandomi-Mohammadabadi 2 ORCID logo

1 Clinical Research of Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
2 Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
3 Student Research Committee, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran
4 Tehran University of Medical Sciences, Tehran, Iran
5 Assistant Professor, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
6 Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran
*Correspondence to Maryam Masoumi, Email: m.masoumiy@gmail.com, mmasoomi@muq.ac.ir

Abstract

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.

Keywords: Methotrexate, Rheumatoid arthritis, Side effects, Hepatotoxicity
Citation: Masoumi M, Balasi J, Aghamiri SM, Moradi S, Baghban M, Vahedian M, Gandomi-Mohammadabadi AR. Side effects of methotrexate therapy in patients with rheumatoid arthritis. Immunopathol Persa. 2021;7(2):e38. DOI:10.34172/ ipp.2021.38.
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