Management of Methotrexate Interruption in Rheumatoid Arthritis

Situations Requiring Methotrexate Interruption

• The American College of Rheumatology recommends interrupting methotrexate in cases of infections requiring antibiotics, which can be resumed after recovery and completion of antibiotic treatment 1
• The European League Against Rheumatism suggests interrupting methotrexate in cases of abnormal liver function (transaminases above twice the upper limit of normal) 1
• Methotrexate should be interrupted in cases of bone marrow suppression (white blood cells <3.5×10^9/L or neutrophils <2×10^9/L) 1
• The American College of Rheumatology recommends considering methotrexate interruption during the perioperative period for certain major surgeries with comorbidities, although methotrexate can be safely maintained for elective orthopedic surgeries 1, 2

Recommendations for Managing Methotrexate Interruption

• Patients should be monitored for signs of inflammatory flare during methotrexate interruption (joint pain, swelling, morning stiffness) 1
• Nonsteroidal anti-inflammatory drugs can be temporarily added during methotrexate interruption if necessary to control symptoms 1