Upper abdominal pain
Folic acid 1mg daily has been shown not to diminish the efficacy of methotrexate and is routinely given. upper abdominal pain Arthritis and female hormones. 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. upper abdominal pain Sacroiliac-joint-pain. 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. upper abdominal pain Upper abdominal pain. 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. Myelosuppression is also rare at the low doses of methotrexate utilized for rheumatoid arthritis. Increased renal insufficiency from other causes or use of trimethoprim (Bactrim, Septra) frequently raises methotrexate levels and cause myelosuppression. In the absence of leukopenia, there has not been conclusive information to link methotrexate use in rheumatoid arthritis with increased risk of infection. The exception is a slight increased risk of localized herpes zoster infection. Although there are case reports of lymphoma associated with methotrexate therapy including a case where the lymphoma resolved after cessation of therapy, increased occurrence of malignancy has not been found in large population based studies. Nor have there been noted effects on sperm production or ovarian function. Women of childbearing potential or men with partners of child bearing potential must understand that methotrexate has potential for teratogenesis and should practice effective birth control.
Upper abdominal pain
Info || Tuberculosis-arthritis || Temporomandibular-joint || Shoulder-pain