Rheumatology

Question 1

What are the serious adverse side effects of Methotrexate to look out for?

Answer 1

Bone marrow suppression (BNF advises to immediately stop methotrexate if a significant drop in either WCC or Plts)
Pneumonitis (Seek advice if dypsnoea, cough, fever)
Liver cirrhosis (BNF advises to urgently discuss any ^ in ALT 3x the upper limit with rheumatology)

Question 2

Which rheumatological drug can cause retinopathy and corneal deposits?

Answer 2

Hydroxychloroquine

Question 3

Which rheumatological drug can cause demyelination?

Answer 3

Etanercept

Question 4

How frequently should bloods be monitored in patients on methotrexate therapy?

Answer 4

FBC, U&Es and LFTs should be done every 1-2 weeks on starting methotrexate until their dose is stable and then should be done every 3 months

Question 5

Which antibiotic is important to avoid in patients on methotrexate and why?

Answer 5

Trimethoprim!!
As it is also another anti-folate drug so increases the risk of bone marrrow suppression