您关于甲氨蝶呤的问题

Can methotrexate cause mouth ulcers?

问)我被诊断出rheumatoid arthritis2003年。2005年我开始英夫利昔单抗和now enjoy a near-normal life. I'm only taking 10 mg of methotrexate a week, folic acid and celecoxib. The infliximab infusions are every eight weeks. Since starting甲氨蝶呤, and prior to infliximab, I've been suffering from a sore mouth with frequent ulcers and swellings which take about a fortnight to clear. I've been seen by various specialists but in the absence of any other diagnosis, methotrexate was cited as the culprit. Have you ever come across these side-effects before and, if so, have you any suggestions on how I may prevent or at least lessen them? Of course, I would prefer not to stop taking methotrexate as the alternative would be unthinkable!

Marilyn, Hampshire - 2009

A)A sore mouth and mouth ulcers are sometimes a side-effect of methotrexate therapy. In my experience it's not uncommon to get these symptoms with this drug. Taking folic acid on the non-methotrexate days will help to minimise the side-effects. Another way of reducing side-effects is to cut down the dose of methotrexate – you're only taking 10 mg, which is a relatively small dose, but even a reduction to 7.5 mg may help. Methotrexate is given along with the anti-TNF (infliximab) to enhance and prolong the effect of the infliximab but other traditional disease-modifying drugs may do the same thing, albeit not as effectively as methotrexate. This is something you may have to take up with your rheumatologist or rheumatology nurse specialist.

This answer was provided by Dr Philip Helliwell in 2009, and was correct at the time of publication.

甲氨蝶呤可以缓慢骨折治愈吗?

问)I haverheumatoid arthritis骨质疏松症。在过去的十年中,我接受了12.5g的治疗甲氨蝶呤每周。

I fell last year and broke my femur, which has been pinned but is healing very slowly. Can methotrexate slow down the healing process?

柴郡莫琳 - 2015年

A)已经显示出较高剂量的甲氨蝶呤可以减慢骨折的愈合,但是由类风湿关节炎引起的炎症也与破坏骨骼的风险以及它们的愈合程度有关。因此,用药物治疗以控制类风湿关节炎的炎症很重要。

If you have osteoporosis and had a fracture you should have been offered treatment with bone-sparing drugs like bisphosphonates to reduce your risk of further fractures. This is something your GP or rheumatologist can advise you on.

该答案由汤姆·马格姆(Tom Margham)博士在2015年提供,在出版时是正确的。

How can I reduce the effects methotrexate has on my hair?

问)作为接受的人甲氨蝶呤为了rheumatoid arthritisI'm concerned at the effect it has on my hair – thinning and falling out. Is there anything that I can take to minimise this effect of the drug?

帕特里夏,伦敦 - 2009年

A)This is an unfortunate side-effect of methotrexate therapy. As doctors, we don’t appreciate how important this is, especially for women. And even low-dose methotrexate can cause hair loss to some extent. The only way to reduce the side-effect is to reduce the dose of the drug, as far as I'm aware. However, taking folic acid on non-methotrexate days usually helps the other side-effects and if you're currently on folic acid just once a week (as some people are) then it might be worth taking it on the six non-methotrexate days.

This answer was provided by Dr Philip Helliwell in 2009, and was correct at the time of publication.

How can I reduce the nausea caused by methotrexate?

问)I've been taking甲氨蝶呤七年来,但是最近恶心的感觉有所增加,在我认为的那一天,我感到非常生病,有时会腹泻。我想了解如何减少这种恶心。我确实服用了处方的叶酸。在我服用甲氨蝶呤的那天,是否有任何食物可以避免或防御?我不想干扰这种药物,这使我能够过上几乎不正常的无痛生活。

M Slater夫人,兰开夏郡 - 2009年

A)有四种解决这个问题的方法。首先,正如您指出的那样,在非甲状腺素时代服用的叶酸可能会有所帮助。人们每周只服用一次或两次叶酸的趋势,因此,如果适用于您,则可以选择将剂量增加到每周六天。其次,您的医生或护士可以给您额外的药丸来阻止恶心。这只需要在同一天与甲氨蝶呤进行。第三,如果您要服用甲氨蝶呤片剂,可以选择通过注射转换为甲氨蝶呤 - 我的很多患者都这样做,发现它更有效,不太可能引起疾病。第四,如果所有其他方法都失败了,则可以减少甲氨蝶呤的剂量,但这可能需要您进行额外的治疗以控制疾病。

This answer was provided by Dr Philip Helliwell in 2009, and was correct at the time of publication.

甲氨蝶呤的副作用有多常见?

问)Methotrexateis on the front of the newspapers a lot recently but my experience on it was not good. As a result of a tiny cut whilst slicing vegetables I spent eight days in hospital on four different antibiotic drips, feeling very ill indeed, and even on release I was still very poorly. Why is this never mentioned in these articles – was I very unlucky or is this common?

艾琳,威勒尔 - 2014年

A)服用甲氨蝶呤的同时感染严重的感染并不常见。但是,甲氨蝶呤确实对免疫系统作用,患者应始终告诉医生和其他医疗保健专业人员是否服用这种药物,尤其是在感染的情况下。我们不知道确切的风险,但很小。例如,一项研究手术后伤口感染的研究发现那些服用甲氨蝶呤的人没有增加。

话虽如此,服用这种药物时,很多人确实感到不适。我怀疑他们坚持不懈的唯一原因是它可以很好地抵抗关节炎。我从病人那里听到的是,他们感到病,疲倦而不是自己。作为医生,我们应该意识到这一点,并试图通过给出最有效的剂量,以使患者感到不适,从而最大程度地减少这些副作用。

This answer was provided by Dr Philip Helliwell in 2014, and was correct at the time of publication.

Is methotrexate and adalimumab causing frequent urination?

问)I am 55 years old and have enduredrheumatoid arthritis其中39个。在过去的五年中,我一直服用甲氨蝶呤,每周20毫克,adalimumab(Humira)每两周40毫克,我非常感谢他们的生活质量。但是,我因两种药物都可以提供的副作用而严重遭受痛苦,这是更频繁的排尿。我需要在白天和黑夜至少每小时,有时甚至更多。这个“问题”对我的生活产生了巨大影响,尤其是使任何旅行成为噩梦。您是否经常听到这种副作用,还是我不幸?

露丝,通过电子邮件 - 2014年

A)这不是我从病人那里听到的。我确实看到患者的感染频率更高,包括膀胱和肾脏感染,我提醒我的患者,当您服用这些药物时,重要的是认真对待任何感染。我们的政策是建议对药物进行暂时停用,直到感染消失为止。

However, it doesn’t sound like that in your case. There are other causes of polyuria (excessive amounts of urine) that could be investigated. (These would include forms of diabetes, including sugar diabetes). Perhaps the first thing to check is the total volume of urine you pass in 24 hours – if you do this make sure you also measure the total volume you drink in the same period and this will help your doctors if they wish to take this further.

This answer was provided by Dr Philip Helliwell in 2014, and was correct at the time of publication.

什么是血清症炎性关节炎,甲氨蝶呤在治疗它方面有多有效?

问)I've recently been diagnosed with seronegative inflammatory arthritis and have been put on methotrexate. Could you please tell me what seronegative inflammatory arthritis is, and what is the long-term prognosis? I'm 65 years of age and healthy, apart from this problem. How different is it from other forms of arthritis? How successful is methotrexate?

维克·西布森(Vic Sibson),肯特郡布罗德斯特楼 - 2008年

A)关节炎通常可以分为血清阳性和血清负荷 - 这是指称为类风湿因子的抗体血液中的存在。大约70%的类风湿关节炎患者是血清阳性的。因此,出现血清素性类风湿关节炎,这可能是您案例的诊断。我之所ankylosing spondylitis,银屑病关节炎reactive arthritis。我的猜测是您没有这些条件之一。血清神经性类风湿关节炎可能与血清阳性类风湿关节炎相同,尽管总体上具有更好的前景。如果您觉得医生没有时间向您解释事情,请尝试与风湿病团队的另一名成员 - 护士,physiotherapist或者occupational therapist, or all three!

This answer was provided by Dr Philip Helliwell in 2008, and was correct at the time of publication.