Methotrexate is one of the most commonly used immunosuppressants in rheumatology. It is inexpensive, extremely convenient to take only once a week, and has a positive effect on the clinical manifestations of arthritis, myositis, pluritis, and rash. It has been internationally recognized as the treatment of choice, either alone or in combination with other slow-acting antirheumatic drugs, and is generally preferred by both rheumatologists and patients.
However, beyond its affordability and efficacy, the potential renal damage of the drug has not been fully evaluated in some cases, especially in patients who already have moderate or greater renal damage, and the metabolites of the drug are likely to be deposited in the renal tubules after administration, further aggravating the pre-existing renal damage and inducing other adverse effects such as interference with metabolism leading to oral mucosal erosions, varying degrees of bone marrow suppression or even secondary infections, etc. In some older patients, the problem is easily ignored because the serum creatinine is only mildly elevated, which does not fully reflect the degree of kidney damage. And the adverse reactions do not appear immediately after the drug is taken, but often after a period of time, more easily ignored, and once the delay in diagnosis and treatment will inevitably cause further harm to patients.
Therefore, rheumatologists usually require patients to have their blood and liver and kidney functions reviewed regularly after taking these slow-acting antirheumatic drugs, so that they can detect the corresponding adverse reactions in time and protect patients from harm. Patients should also understand the adverse effects of these drugs scientifically and rationally, neither exaggerate the fear, nor take it lightly, and cooperate seriously with the doctor’s diagnosis and treatment, so that various hidden dangers can be controlled in the bud.