Antibiotics, Methotrexate, and Flare-Ups

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Oh, no! This can’t be happening.

Do you ever find yourself saying such phrases in your head or under your breath when your rheumatoid-arthritis (RA) hands begin to not feel so good?

Recently I had to go off of my methotrexate for a few weeks and that’s when those phrases came back into my life. Because I had an infection and needed to take antibiotics, I was advised to not take the methotrexate during this time.

Interaction: methotrexate and antibiotics

It is very important to avoid taking antibiotics and methotrexate at the same time for two reasons. First, methotrexate can be very effective in treating RA. However, it should be administered with care, as there is a narrow line between a therapeutic and a toxic dose of the drug. Second, it may have an interaction with other medications. For instance, a number of antibiotics affect how quickly methotrexate is absorbed in the body, thus potentially leading to a buildup, which may become toxic.

Antibiotics that can interact with methotrexate include the following:

  • Penicillin
  • Ciprofloxacin
  • Amoxicillin
  • Dapsone
  • Neomycin
  • Bactrim

These antibiotics interact with the way methotrexate is metabolized in the kidneys, potentially reducing the rate with which it is processed. This can lead to a buildup that can slowly cause toxicity.

If you are diagnosed with an infection that requires antibiotics, wait at least 12 hours after taking methotrexate to allow most of the methotrexate to clear the kidneys. You may wish to talk to your rheumatologist about their recommended protocol before you get an infection so you know what to do in advance.

What happened when I stopped methotrexate

Fortunately, the antibiotics killed my infection. Unfortunately, the RA mischiefs decided that it would be a good time to act up a bit.

The pain started with an extra stiffness in my left hand. I thought that maybe I was typing too much or playing too many computer games where I hold my hand in a lose fist and typically use just one finger. But after a few days, it was my left foot that joined in the party. Moving my toes became a practice in slow motion. When my boyfriend offered a foot rub (I wouldn’t ever want to turn down or discourage a foot rub), I couldn’t stand the pressure or even the gentle movement of my toes.

Seriously, who turns down a foot rub?

Since starting methotrexate in 2007 and Rituxan in 2009, I have been blessed with relatively low disease activity. But even with Rituxan in my system, I absolutely need to continue taking methotrexate. If I skip a dose, I can feel it.

The fear of flaring RA

The fear of not finding relief becomes so great that it is hard to look at. The fear of what this disease “wants” to do if left unchecked can become powerful. The fear of losing a grasp on remission was the greatest unspoken fear I experienced during this time. I was anxious to get back on all my meds again.

Getting back to my meds proved to be effective. It wasn’t immediate, but the pain and swelling did recede. My body returned to “normal” after a couple of weeks and I was able to move on. But I wonder about this type of transient flare-up and I wonder about the remission which only sustains while continuing medication.

Is it a true remission?

I don’t know the honest answer to that question and will ask my rheumatologist during our next visit. What I do know is that the fear of RA coming back full-force is real. Thankfully, my experience was a temporary one. Not everyone is so fortunate and I know I’m lucky.

Update by: Lene Andersen

See more helpful articles:

What You Need to Know About Methotrexate

Can RA Go into Remission or Disappear

Adaptation: Learning to Live With RA