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| LETTER |
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| Year : 2012 | Volume
: 58
| Issue : 1 | Page : 86 |
Methotrexate - Controversially yours
RV Lohiya
Department of Medicine, B. J. Medical College, Pune, Maharashtra, India
| Date of Web Publication | 25-Feb-2012 |
Correspondence Address:
R V Lohiya
Department of Medicine, B. J. Medical College, Pune, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0022-3859.93264
How to cite this article:
Lohiya R V. Methotrexate - Controversially yours. J Postgrad Med 2012;58:86 |
Sir,
Methotrexate (Mtx) has been a great savior for patients of especially rheumatoid arthritis (RA) and it is now one of the most utilized disease-modifying agents for RA (DMARDs). Adverse effects associated with use of Mtx have always been a topic of discussion. In the article [1] the author has described intestinal perforation in a patient of RA which has been proposed to be due to prolonged use of Mtx. The author has also discussed associated ultrastructural changes in the intestinal epithelium. However, a review of the literature suggests multiple possible etiologies for intestinal perforation, peptic ulcer disease (PUD) being the commonest. Farah et al., [2] in their study observed that RA patients have a higher risk of PUD compared to normal age and sex-matched population. Peptic ulceration in RA is often asymptomatic and this may be partly owing to the analgesic and anti-inflammatory effect of the DMARDs taken by these patients. [2] Thus the given case scenario is suggestive of asymptomatic PUD complicating into perforation and the possible etiologies are RA, non-steroidal anti-inflammatory agents or DMARDs. Associating given complication to methotrexate needs exclusion of all other commoner causes and further large-scale studies.
| :: References | |  |
| 1. | Gude D, Chinnam GS, Bansal DP. An uncommon catastrophe associated with methotrexate. J Postgrad Med 2011;57:261-2. 
[PUBMED]  |
| 2. | Farah D, Sturrock RD, Russell RI. Peptic ulcer in rheumatoid arthritis. Ann Rheum Dis 1988;47:478-80.
[PUBMED] [FULLTEXT] |
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