Slow-acting anti-rheumatic drugs (DMARDs) are oral classes of drugs commonly used in the treatment of psoriatic arthritis to slow down joint destruction and progression of the disease, commonly used drugs such as methotrexate. Some people may be shocked to see the instructions of these drugs: (Methotrexate) is used to treat various types of acute leukemia, breast cancer, lung cancer, psoriasis ……; adverse effects include bone marrow suppression, liver function impairment, gastrointestinal discomfort, etc. This drug is also used to treat cancer, will it have particularly high side effects? With this part of the patients’ doubts, we asked Dr. Liao Zetao of the Department of Rheumatology and Immunology at the Zhongshan Third Hospital. ”When methotrexate is used for psoriatic arthritis treatment, the usual dosage is 10-15mg (i.e. 4-6 tablets) per week, which is very different from the dosage for oncology treatment. For the possible side effects of the drug, most patients do not need to worry too much as long as they are monitored reasonably; and patients who have abnormal liver function or are sensitive to drug reactions themselves, there are ways to solve the problem such as adjusting and changing the medication.” Dr. Liao Zetao said. Mildly elevated transaminases do not affect treatment If patients with psoriatic arthritis do not have liver problems themselves, they can recheck glutathione and glutamic oxalacetic transaminase two weeks after using the immunosuppressant; and again a month after that to assess whether it is appropriate to use the drug. “Generally do not exceed 1.5 times the normal range (i.e. 0-40 U/L), for example, about 50-60, which does not affect the treatment plan, but at the same time should be combined with some liver protection drugs; after that it is enough to review at the hospital every three months. However, if the liver function index reaches 2-3 times the normal value, it is necessary to reduce the dosage or change the medication: if the patient’s economic condition allows, he can switch to biological agents; if the economic condition is limited, he needs to suspend the treatment and take liver-protective drugs. After the liver function improves, then choose anti-rheumatic drugs with less liver damage.” Dr. Liao Zetao advises. If a patient with psoriatic arthritis has underlying liver disease (such as viral hepatitis), the side effects of some anti-rheumatic drugs on the liver will be more obvious, such as methotrexate. In patients with combined hepatitis B, anti-rheumatic drugs can cause the hepatitis B virus in the body to replicate, which requires the appropriate use of some anti-hepatitis B virus drugs. Regularly check white blood cells to monitor bone marrow suppression After the use of anti-rheumatic drugs in patients with psoriatic arthritis, some patients are more sensitive to the drugs and may experience adverse reactions of bone marrow suppression: blood cell reduction, thrombocytopenia anemia, etc. To avoid this, patients need to review their blood cells more closely at the beginning of treatment, and can do so once every three months after their disease has been remitted and their treatment regimen has stabilized. Take the most common example of leukopenia, if the white blood cells are only slightly below normal, you can continue with the medication and keep observing, while taking common white-raising drugs such as shark liver alcohol and vitamin B4 to assist in the treatment. However, if the leukocytes are significantly reduced, usually below 3.0*109/L, Dr. Liao Zetao believes that such patients should stop the medication immediately and be treated accordingly. Many patients worry that oral anti-rheumatic drugs for psoriatic arthritis “hurt the stomach”, in fact, most patients’ gastrointestinal reactions are not very obvious, mostly mild nausea, abdominal pain, bloating, indigestion, anorexia, etc., and can be improved after symptomatic treatment of stomach protection. In addition, the commonly used DMARD is not strictly immunosuppressive and does not affect the immunity of the whole body and does not significantly increase the risk of tuberculosis, pneumonia and other infectious diseases.