Oral vs. subcutaneous low-dose methotrexate treatment  in reducing gastrointestinal side effects

The aim of our present data was to compare the gastrological side effects of oral versus subcutaneous (SC) administration of methotrexate in patients with long-lasting rheumatoid arthritis (RA). We compared the intensity of gastrological side effects such as nausea, vomiting, loss of appetite, abdominal pain and diarrhea in patients who received methotrexate (MTX) in oral or subcutaneous doses of either 7.5 mg or 15 mg weekly. The survey research was used to evaluate the intensity of the above-mentioned side effects. The questionnaires were completed by a doctor, who conducted a structured interview with patients. Patients receiving oral MTX had more intense gastrological side effects. There was a correlation between dose of oral MTX and intensity of side effects. Patients receiving 15 mg MTX orally had significant severe vomiting and loss of appetite (p < 0.05). Nausea and loss of appetite turned out to be the most frequent side effects in patients receiving SC MTX 15 mg/weekly. In contrast to patients from the oral MTX groups none from the SC MTX groups exhibited vomiting or diarrhea. We found that SC MTX administration demonstrated a significant reduction of gastrological side effects’ intensity compared with oral administration of the same MTX dosage among patients with long-lasting RA. We also observed the possibility of dosage reduction of other DMARDs. Using SC MTX therapy allowed 50% oral dosage reduction in 14.6% of patients among patients who received them.

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