Muhammad Meraj, Inam Ullah Khan, Abdus Saboor Awan, Munir Ahmad Abbasi.
Incidence of Adverse Drug Reactions to Methotrexate in patients with Rheumatoid Arthritis.
Ophthalmol Update Jan ;16(3):745-8.

Background: Methotrexate is a first line disease modifying anti-rheumatic drug which is considered a first line option for the management of rheumatoid arthritis. It is usually administered for long duration in low-to-high doses depending on disease activity. Methods: This descriptive cross sectional study was conducted at the District Headquarters Hospital, Battagram from 01/08/2016 to 31/07/2017. A total of 93 patients with rheumatoid arthritis who had been taking methotrexate in doses up to 20 mg were enrolled in the study and were investigated for development of adverse reactions on four monthly follow-up visits. Results: Adverse effects of methotrexate were observed in 28 (30.18%) participants. Most common adverse effects were hepatotoxicity (13.98%), anemia (11.83%) and leucopenia (4.30%). Nausea and vomiting was reported in 2.15% patients. Participants who developed hepatotoxicity and anemia not responding to increase in folic acid had to discontinue methotrexate because of adverse effects. Conclusion: Methotrexate associated adverse effects are a common occurrence in the management of rheumatoid arthritis and physicians should have a low-threshold for detection and timely management of these adverse effects.

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