Methotrexate - Controversially yours

RV Lohiya 
 Department of Medicine, B. J. Medical College, Pune, Maharashtra, India

Correspondence Address:
R V Lohiya
Department of Medicine, B. J. Medical College, Pune, Maharashtra
India

Full Text

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