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Salicylates (and other NSAIDs) and trimethoprim (Bactrim, Septra) block the renal excretion of methotrexate and leads to higher serum levels and potential toxicity. chest pain ccause, wrist pain, psoriasic arthritis, narcotic pain medication, pain scale, rheumatiod arthritis, gold shots for rheumatoid arthritis, joint replacement, national arthritis, information about rheumatoid arthritis Joint replacement. If alternatives exist, concomitant use of methotrexate and trimethoprim is to be avoided. NSAIDs and methotrexate are often used together, but methotrexate toxicity monitoring should be done more frequently when adding or changing NSAIDS while on methotrexate therapy. Usual Time to Maximal Effect: The onset of action is 4 to 6 weeks, with 70% of patients having some response. chest pain ccause, wrist pain, psoriasic arthritis, narcotic pain medication, pain scale, rheumatiod arthritis, gold shots for rheumatoid arthritis, joint replacement, national arthritis, information about rheumatoid arthritis Pain scale. A trial of 3 to 6 months is suggested. Side Effects: Fortunately the most serious complications of methotrexate therapy: hepatic cirrhosis, interstitial pneumonitis and severe myelosuppression are rare. Stomatitis, mild alopecia and GI upset may occur and are related to folic acid antagonism and can be improved with folic acid supplementation. chest pain ccause, wrist pain, psoriasic arthritis, narcotic pain medication, pain scale, rheumatiod arthritis, gold shots for rheumatoid arthritis, joint replacement, national arthritis, information about rheumatoid arthritis Pain in heel of foot. Folic acid 1mg daily has been shown not to diminish the efficacy of methotrexate and is routinely given. Before starting methotrexate, baseline studies should include complete blood count, liver chemistries, serum creatinine, hepatitis B and C serologies and chest radiography. Routine toxicity monitoring should include a CBC, liver profile, serum albumin and serum creatinine every 4-8 weeks. Hepatotoxicity has not been significant if patients with pre-existing liver disease, alcohol abuse, or hepatic dysfunction are excluded from treatment. Patients are instructed to stop all alcohol containing beverages. Baseline or surveillance liver biopsies are not indicated unless pre-existing liver disease is suspected. Elevated liver enzymes do not directly correlate with toxicity but therapy should stop if transaminases are elevated to 3 times the upper limit of normal. Liver biopsy should be done if elevated liver enzymes persist or if methotrexate therapy is to be continued. Interstitial pneumonitis is rare (2%), but the clinician should be alert to symptoms of cough or shortness of breath that may herald the onset of this severe complication. Methotrexate pneumonitis may occur at any time during therapy and is not dose related. A baseline chest x-ray is useful for comparison. Patients with poor pulmonary reserve from other causes may be excluded from therapy over concerns of increased morbidity if methotrexate pneumonitis occurs.
Chest pain ccause, wrist pain, psoriasic arthritis, narcotic pain medication, pain scale, rheumatiod arthritis, gold shots for rheumatoid arthritis, joint replacement, national arthritis, information about rheumatoid arthritis
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