Summary
To assess the frequency and clinical characteristics of methotrexate (MTX) oral toxicity in rheumatoid arthritis (RA) patients, 51 RA patients receiving MTX and 46 RA patients not receiving MTX were studied. A questionnaire, the credibility of which was tested on four separate patient groups including a group with Behcet's Syndrome, was used as a tool to determine the prevalence of stomatitis by a blind observer. In this first controlled study of the oral toxicity of MTX, prevalence of stomatitis was found in 37.2% in the group taking MTX and 19.5% in the group not taking MTX (P=0.054). No statistical differences were detected with respect to number, duration, frequency, and site of stomatitis. Two of the 51 MTX taking patients temporarily reduced their MTX dosage and only one patient temporarily terminated MTX treatment. MTX and toxicity is usually of no major clinical concern in the treatment of RA.
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References
Alarcon, G.S., Tracy, I.C., Blackburn, W.D. Methotrexate in limiting long-term treatment. Arthritis Rheum 1989, 32, 671–677.
Brooks, P. Current issues of methotrexate and cyclosporine. Current Opinion in Rheumatol 1992, 4, 309–313.
Buchbinder, R., Hall, S., Sambrook, P.N., et al. Methotrexate therapy in rheumatoid arthritis: A life table review of 587 patients treated in community practice. J Rheumatol 1993, 20, 639–644.
Felson, D.T., Anderson, J.J., Meenan, R.F. Use of short term efficacy-toxicity tradeoffs to select second-line drugs in rheumatoid arthritis. Arthritis Rheum, 1992, 35, 1117–1125.
Hamuryudan, V. Behcet Sendromu aftlarinda lokal alfainterferon tedavisi: Plasebo kontrollu cift kor bir calisma. MD Thesis, Cerrahpasa Medical Faculty, Istanbul, 1991.
Kremer, J.M., Phelps, J.T. Long-term prospective study of the use of methotrexate in the treatment of rheumatoid arthritis. Arthritis Rheum 1992, 35, 138–145.
Main, D.M.G., Chamberlain, M.A. Clinical differentiation of oral ulceration in Behçet's disease. Br J Rheumatol 1992, 31, 767–770.
McKendry, R.J.R., Dale, P. Adverse effects of low dose methotrexate therapy in rheumatoid arthritis. J Rheumatol 1993, 20, 1850–1856.
Montecucco, C., Caporali, R., Rossi, S., Porta, C. Allopurinol mouthwashes in methotrexate-induced stomatitis. Arthritis Rheum 1993, 37, 777–779.
Morand, E.F., McCloud, P.L., Littlejohn, G.O. Life table analysis of 879 treatment episodes with slow acting antirheumatic drugs in community rheumatology practice. J Rheumatol 1992, 19, 704–708.
O'Duffy, J.D. Vasculitis in Behçet's disease. Rheumatic Dis Clin of N Am 1990, 16, 123–131.
Redding, S.W. Dental correlation: chemotherapy. In: Internal Medicine for Dentistry. Eds.: L.F. Rose and D. Kaye. The C.V. Mosby Co., St. Louis, 2nd ed., Section VI; 1990, pp. 390–393.
Rooney, T.W. Methotrexate. In: Arthritis and Allied Conditions. 12th ed. Eds.: D.J. McCarty and W.J. Koopman. Lea & Febiger Co., Philadelphia, 1993, Chapter 34, pp. 621–637.
Shiroky, J.B., Neville, C., Esdaile, J.M. et al. Low-dose methotrexate with leucovorin in the management of rheumatoid arthritis. Arthritis Rheum 1993, 36, 796–803.
Singh, G., Fries, J.F., Williams, C.A. et al. Toxicity profiles of disease modifying antirheumatic drugs in rheumatoid arthritis. J Rheumatol 1991, 18, 188–194.
Tugwell, P., Bennett, K., Gent, M. Methotrexate in rheumatoid arthritis. Ann Intern Med 1987, 107, 358–366.
Weinblatt, M.E., Kaplan, H., Germain, B.F. et al. Methotrexate in rheumatoid arthritis: Effects on disease activity in a multicenter prospective study. J Rheumatol 1991, 18, 334–338.
Weinblatt, M.E., Maier, A.L., Coblyn, J. Low dose leucovorin does not interfere with the efficacy of methotrexate in rheumatoid arthritis: An eight-week randomized placebo controlled trial. J Rheumatol 1993, 20, 950–952.
Wolfe, F., Hawley, D.J., Cathey, M.A. Termination of slow acting antirheumatic therapy in rheumatoid arthritis: A 14-year prospective evaluation of 1017 consecutive starts. J Rheumatol 1990, 17, 994–1002.
Wolfe, F., Cathey, M.A. The effect of age on methotrexate efficacy and toxicity. J Rheumatol 1991, 18, 973–977.
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Ince, A., Yazici, Y., Hamuryudan, V. et al. The frequency and clinical characteristics of methotrexate (MTX) oral toxicity in rheumatoid arthritis (RA): A masked and controlled study. Clin Rheumatol 15, 491–494 (1996). https://doi.org/10.1007/BF02229648
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DOI: https://doi.org/10.1007/BF02229648