July 2022

We were told that taking B12 supplements every 12-24 hrs may help ease nausea as well as taking folic acid 5mg the day after MTX. How effective is this is managing side effects and intolerance?

By |July 14th, 2022||

There is no evidence to recommend vitamin B12 supplementation to help ease nausea or other side effects of methotrexate. Pediatric rheumatologists usually prescribe folic acid or folinic acid (leucovorin) supplementation, which helps reduce some of the methotrexate side effects, such as stomach upset, nausea and liver toxicity. There are many ways of prescribing folic [...]

My daughter does not find anti-sickness drugs to help her nausea in any way, which can last 48 hrs each week. Is there anything else that she can try?

By |July 14th, 2022||

There are many ways to help reduce nausea caused by methotrexate. Reducing the dose, changing its route of administration (pills versus subcutaneous injections), and splitting the dose if given orally, may be proposed by your pediatric rheumatology care team. Other suggestions may include giving it at bedtime during the weekend so it does not [...]

What are the ways that the side effects manifest themselves and how do you cope with them?

By |July 14th, 2022||

Pediatric rheumatologists may prescribe various classes of medications to treat juvenile idiopathic arthritis. Each medication or class of medication has its own side effect profile. Some side effects may be prevented or reduced in various ways (for example: by reducing the dose, changing the administration schedule, or prescribing additional medication). If you believe you/your [...]

Can you explain the immunosuppression related to methotrexate? Is it immunosuppressing or immunomodulating and can you explain the difference?

By |July 14th, 2022||

Methotrexate (MTX) is considered a mild immunosuppressing medication. It works by decreasing the activity of certain types of white blood cells (WBCs). WBCs are also a part of our body’s immune defense against infections, thus by definition MTX does suppress the immune system to a mild degree. However, WBCs are overactive in autoimmune diseases [...]

My son has been on 10 MG of oral methotrexate/week for five months. He also started Humira 3 weeks ago. His disease has been getting worse since diagnosis.  Do you think increasing the methotrexate dosage would help to slow the progression of the disease?

By |July 14th, 2022||

The dose of methotrexate is generally prescribed by a child’s weight, with the dose calculated based on a calculated body surface area. Your pediatric rheumatologist will suggest dosing changes in your child’s medication depending on several factors including having a reasonable trial of a new medication, such as Humira that your child just started. [...]

When and why should we combine Naproxen with MTX?

By |July 14th, 2022||

Many children with JIA will take Naproxen and methotrexate together. Naproxen is a medication with pain relieving properties, and has some anti-inflammatory effect as well when taken regularly. Methotrexate is not a pain relieving medication, but works to control inflammation in a very different way from Naproxen. Many children have good disease control with [...]

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