Summary
Twelve patients with rheumatoid arthritis treated for at least 12 months with methotrexate and 11 matched rheumatoid arthritis controls underwent a standard d-xylose absorption test. No patients had any pre-existing clinical of biochemical evidence of malabsorption. No significant difference was observed in the 1 hour plasma d-xylose estimation between methotrexate treated patients and controls. The 2 to 5 hour urinary excretion ratio, however, was significantly lower in the methotrexate-treated group compared with controls indicating a minor degree of malabsorption. Six of the methotrexate treated patients and 5 of the controls underwent endoscopic duodenal biopsy but neither group demonstrated any significant histological changes. In conclusion, methotrexate therapy in patients with rheumatoid arthritis produces mild intestinal malabsorption.
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Thompson, R.N., Watts, C., Edelman, J., Esdaile, J., Russell, A.S. A controlled two-centre trial of parenteral methotrexate therapy for refractory rheumatoid arthritis. J Rheumatol 1984, 11, 760–3.
Kremer, J.M., Lee, J.K. The safety and efficacy of the use of methotrexate in long-term therapy for rheumatoid arthritis. Arthritis Rheum 1986, 29, 822–31.
Alarcon, G.S., Tracy, I.C., Blackburn, W.D. Jr. Methotrexate in rheumatoid arthritis. Toxic effects as the major factor in limiting long-term treatment. Arthritis Rheum 1989, 32, 671–6.
Croft, A.W., Kay, H.E.M., Lawson, D.N. McElwain. Methotrexate-induced malabsorption in children with acute lymphoblastic leukaemia. BMJ 1977,2, 1511–2.
Baird, G.M., Dossetor, J.F.B. Methotrexate enteropathy. Lancet 1981, 1, 164.
Pinkerton, C.R., Glasgow, J.F.T. Methotrexate enteropathy? Lancet 1981, 1, 966.
Pinkerton, C.R., Cameron, C.H.S., Sloan, J.M., Glasgow, J.F.T., Gwevava, N.J.T. Jejunal crypt cell abnormalities associated with methotrexate treatment in children with acute lymphoblastic leukaemia. J Clin Pathol 1982, 35, 1272–7.
Gwevava, N.J.T., Pinkerton, C.R., Glasgow, J.F.T., Sloan, J.M., Bridges, J.M. Small bowel enterocyte abnormalities caused by methotrexate treatment in acute lymphoblastic leukaemia. J Clin Pathol 1981, 34, 790–5.
Trier, J.S. Morphological alterations induced by methotrexate in the mucosa of human proximal intestine. Gasteroenterology, 1962, 42, 295–304.
Arnett, F.C., Edworthy, S.M., Bloch, D.A. et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988, 31, 315–24.
Haeney, M.R., Culank, L.S., Montgomery, R.D., Sammons, H.G. Evaluation of xylose absorption as measured in blood and urine: A one-hour blood xylose screening test in malabsorption. Gasteroenterology 1978, 75, 393–400.
Dyer, N.H., Kendall, M.J., Hawkins, C.F. Malabsorption in rheumatoid disease. Ann Rheum Dis 1971, 30, 626–30.
Taulor, S.G., Hass, G.M., Crumrine, J.L., Slaughter, D.P. Toxic reactions of 4-aminopterylglutamic acid in patients with far advanced neoplastic disease. Cancer 1950, 3, 493–503.
Craig, R.M., Atkinson, A.J. Jr. D-xylose testing: A review. Gasteroenterology, 1988, 95, 223–31.
Furst, D.E., Erikson, N., Clute, L., Koehnke, R., Burmeister, L.F., Kohler, J.A. Adverse experience with methotrexate during 176 weeks of a longterm prospective trial in patients with rheumatoid arthritis. J Rheumatol 1990, 17, 1628–35.
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Phelan, M.J.I., Taylor, W., van Heyningen, C. et al. Intestinal absorption in patients with rheumatoid arthritis treated with methotrexate. Clin Rheumatol 12, 223–225 (1993). https://doi.org/10.1007/BF02231531
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DOI: https://doi.org/10.1007/BF02231531