Methotrexate in Rheumatoid Arthritis: Effect on Blood, Liver and Renal Laboratory Parameters
Keywords:
Rheumatoid arthritis, Methotrexate, Laboratory parameters, Monitoring, Response, Drug safetyAbstract
Objective: To evaluate the effect of Methotrexate on blood, liver and renal laboratory parameters in patients having rheumatoid
arthritis.
Materials and Methods : A 24-week, single-blind, interventional study was carried out on 155 consecutive patients, aged 29-
70 years, diagnosed with rheumatoid arthritis. They received tablet Methotrexate, 10 mg (2.5 mg, 4 tablets) weekly, orally.
Laboratory tests like hemoglobin level, total white cell and platelet counts, erythrocyte sedimentation rate, serum glutamic
pyruvic transaminase and serum creatinine levels were recorded at the initial visit as well as at 6, 14 and 24 weeks follow-up
visits.
Results: At the end of 24 weeks hemoglobin level increased to 12.43 ± 0.92 grams per deciliter (g/dl) from a baseline of 10.76
± 1.12 g/dl, white cell count fell to 7,142.46 ± 1332.23 per cubic mm (cmm) from 8,572 ± 1445/cmm, the ESR fell to 40.14
±15.78 mm of Hg in 1st hour from 81.03 ±17.98 mm of Hg, the platelet count fell to 2, 33,738.10 ± 59,769/ cmm from 2, 90,278
± 68,813/cmm, the SGPT levels increased to 55.29 ± 21.97 international units per litre (IU/l) from 31.67 ± 7.37 IU/l and the
serum creatinine increased to 1.11 ± 0.14 mg/dl from 0.95 ± 0.16 mg/dl, all values being highly significant statistically (p<0.001).
Conclusion: Methotrexate exerted significant effects on the blood, liver and renal laboratory parameters. These parameters
may be utilized for monitoring the response and safety of methotrexate use in RA.
References
Allaire SH, Prashker MJ, Meenan RF. The costs of rhe-
umatoid arthritis. Pharmaco Economics. 1994; 6:513–22
Del Puente A, Knowler WC, Pettit DJ, Bennett PH. High
incidence and prevalence of rheumatoid arthritis in Pima
Indians. Am J Epidemiol. 1989; 129:1170-8
Akhter E, Bilal S, Kiani A, Haque U. Prevalence of art-
hritis in India and Pakistan: a review. Rheumatol Int.
; 31(7):849-55
Hameed K, Gibson G, Kadir M. The prevalence of rheu-
matoid arthritis in affluent and poor urban communities
of Pakistan. Br J Rheumatol. 1995; 34:252-6
Pisetsky DS. Laboratory testing in rheumatic diseases.
Ch 278 in Cecil’s Medicine, eds. Goldman L, Aesiello
D. Saunders, Elsevier. 2007; 23rd ed: 1967
Álvarez-Lafuente R, Fernández-Gutiérrez B, Miguel S
de, Jover JA, Rollin R, Loza E et al. Annals of the Rheu-
matic Diseases. 2005; 64:1357-9
Ferrell PB, Aitcheson CT, Pearson GR, Tan E.M. Sero-
epidemiological study of relationships between Epstein-
Barr virus and rheumatoid arthritis. J Clin Invest. 1981;
(3): 681-7
Catalano MA, Carson DA, Slovin SF, Richman DD,
Vaughan JH. . Proc. Natl. Acad. Sci. USA, Immunology.
; 76 (11):5825-8
Balandraud N, Roudier J. Epstein–Barr virus and rheu-
matoid arthritis. Autoimmunity Reviews. July 2004; 3
(5):362-7
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fr-
ies JF, Cooper NS et al. Arthritis Rheum. 1988; 31 (3):
-24
Plant MJ, Saklatvala J, Borg AA, Jones PW, Dawes PT.
Measurement and prediction of radiological progression
in early rheumatoid arthritis. J Rheumatol. 1994; 10:1808-
O'Dell J. Therapeutic strategies for rheumatoid arthritis.
N Engl J Med. 2004; 350 (25): 2591-602
Hasler P. Biological therapies directed against cells in
autoimmune disease. Springer Semin Immunopathol.
; 27 (4): 443-56
Ward MM , Fries JF. Trends in anti-rheumatic medication
use among patients with rheumatoid arthritis,1981-1996.
J Rheumatol. 1998; 25:408-16
Eustice C. The facts of Methotrexate. Updated May, 17,
, about.com guide
Kaltsonoudis E, Papagoras C, Drosos AA. Current and
future role of methotrexate in the therapeutic armamenta-
rium for rheumatoid arthritis; Int J Clin Rheumatol.
;7(2):179-89
Lopez-Olivo MA, Siddhanamatha HR, Shea B, Tugwell
P, Wells GA, Suarez-Almazor ME. Methotrexate for
treating rheumatoid arthritis. Cochrane Database Syst
Rev. Jun 10, 2014
Combe B, Landewe R, Lukas C. EULAR recommenda-
tions for the management of early arthritis: report of a
task force of the European Standing Committee for Int-
ernational Clinical Studies Including Therapeutics
(ESCISIT). Ann Rheum Dis. 2007; 66:34-45
Quemeneur L, Gerland LM, Flacher M, French M,
Revillard JP, Genestier L. Differential control of cell
cycle, proliferation and survival of primary T lympho-
cytes by purine and pyrimidine nucleotides. J Immunol.
; 170: 4986-95
Nesher G, Osborn TG, Moore TL. In vitro effects of
Methotrexate on polyamine levels in lymphocytes from
rheumatoid arthritis patients. Clin Exp Rheumatol. 1996;
: 395-9
Phillips DC, Woollard KJ, Griffiths HR. The anti-inflam-
matory actions of Methotrexate are critically dependent
upon the production of reactive oxygen species. Br J
Pharmacol. 2003; 138: 501-11
Sung JY, Hong JH, Kang HS, Choi I, Lim SD, Lee JK
et al. Methotrexate suppresses the interleukin-6 induced
generation of reactive oxygen species in the synoviocytes
of rheumatoid arthritis. Immunopharmacology. 2000;
: 35-44
Whittle SL, Hughes RA. Folate supplementation and
Methotrexate treatment in rheumatoid arthritis: a review;
Rheumatology, 2004, 43 (3): 267-71
Hazra SC, Choudhury AM, Khondker L, Khan MSI,
Ahmed N. Hematological and Biochemical Parameter
Changes Related to Methotrexate Therapy; Bangladesh
Medical Journal 2011; 40(3):40-3
Nemazee D, Hogquist KA. Antigen receptor selection
by editing or down regulation of V (D) J recombination.
Curr. Opin. Immunol. 2003; 15: 182-9
Ortiz Z, Shea B, Suarez-Almazor ME, Moher D, Wells
GA, Tugwell P. The efficacy of folic acid and folinic
acid in reducing methotrexate gastrointestinal toxicity
in rheumatoid arthritis. A meta-analysis of randomized
controlled trials. J Rheumatol. 1998; 1:36-43
Emery P, Breedveld FC, Lemmel EM, JP, B et al. A
comparison of the efficacy & safety of Leflunomide and
Methotrexate for the treatment of rheumatoid arthritis.
. 2000; 39(6)655-65
Ishaq M, Muhammad JS, Hameed K, Mirza AI. Leflun-
omide or methotrexate? Comparison of clinical efficacy
and safety in low socio-economic rheumatoid arthritis
patients, Mod Rheumatol 2011; 21(4): 375-80
Londono J, Santos AM, Santos PI, Cubidez MF, Guzman
C, Valle-Oñate R. Therapeutic efficacy and safety of
methotrexate + leflunomide in Colombian patients with
active rheumatoid arthritis refractory to conventional
treatment, Rev. Bras. Reumatol.2012; 52 (6):837-45
Attar SM, Adverse effects of low dose methotrexate in
rheumatoid arthritis patients. A hospital-based study.
; 31(8):909-15
Alves JANR, Fialho SCS, Morato EF, de Castro GRW,
Ribeiro GG, Zimmermann AF et al. Liver toxicity is
rare in rheumatoid arthritis patients using combination
therapy with leflunomide and methotrexate. São Paulo.
Rev. Bras. Reumatol. 2011; 51(2): 141-4
Morgan SL, Baggott JE, Vaughn WH. Supplementation
with folic acid during methotrexate therapy for rheum-
atoid arthritis. A double-blind, placebo-controlled trial.
Ann Intern Med. 1994; 121:833-41
Tousson E, Zaki ZT, Abu-Shaeir W A, Hassan H. Metho-
trexate-induced Hepatic and Renal Toxicity: Role of Lcarnitine
in Treatment. Biomedicine and Biotechnology,
, 2(4), 85-92
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2015 Fuad Shaikh, Rabia Arshad, Fahad Azam, Nasim Karim
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0