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Sarcoidosis

Methotrexate

07/17/2007

Question:

I have started a trial of methotrexate. I truly do not understand what the purpose of the methotrexate is. Can you explain it to me and how I will know if it is working. I have had elevated crp`s for years. The rheumatologist said continued elevated inflamatory reactions could cause heart disease. I understand that, I am just understanding the effect methotrexate will have. Thank you for your time.

Answer:

Methotrexate interferes with a specific metabolic pathway in rapidly dividing cells, including activated immune cells. This results in a reduction in the immune response. At very high doses, methotrexate can be used as a "chemotherapy", but when used at lower doses (less than 20 milligrams/week) it is a good anti-inflammatory drug. It is commonly used at lower doses for rheumatoid arthritis, psoriasis and for sarcoidosis.

Side-effects of methotrexate include headaches, diarrhea, suppression of the immune system, and liver problems. Therefore, monitoring of the blood (immune cell counts, liver enzyme levels) is recommended and the dose may have to be adjusted if side-effects are observed.

It is important to know that the drug usually takes more than a month to have its full effect. You should take supplemental folic acid (a B-vitamin), 1 milligram/day, to reduce the incidence of adverse side-effects. Used properly, methotrexate is safe and effective for the treatment of sarcoidosis, and usually allows the doctor to decrease the dose of other drugs (e.g., steroids) that would otherwise have very bad side-effects over time.

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Response by:

Elliott D Crouser, MD Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University