Methotrexate is given weekly as an intramuscular injection of 15 to 25 mg. Side effects are rare and include leukopenia and hypersensitivity interstitial pneumonitis. Hepatic fibrosis is the most severe potential sequela of long-term therapy. Patients with concomitant alcohol abuse and/or morbid obesity are more likely to develop hepatic fibrosis and therefore should not be treated with methotrexate. It is prudent to obtain a baseline chest radiograph and to monitor complete blood count, liver function and renal function every two weeks until the patient is receiving oral therapy, and every one to three months thereafter. Before methotrexate therapy is initiated, the risks of treatment and the possible need for a liver biopsy should be discussed with the patient.
Dexamethasone is given systemically to decrease inflammatory and immune responses. It is used in high doses in emergencies for anaphylactic reactions, spinal cord trauma or shock. It is used in lower doses to treat allergic reactions such as Chronic Obstructive Pulmonary Disease (COPD), hives, itching, inflammatory diseases including arthritis and to manage and treat immune mediated hemolytic anemia and thrombocytopenia. It sometimes is used systemically as a "performance-enhancing” drug because corticosteroids decrease inflammation, possibly enhance glucose metabolism (there is some debate about this) and may have some mood elevating properties. Other corticosteroids are preferred for intra articular use.
Using a nationwide dataset of private insurance claims, researchers identified patients aged 18–64 years who were enrolled from 2012–2014. The main outcomes included rates of short-term use of oral corticosteroids (defined as <30 days duration), rates of adverse events in corticosteroid users vs. non-users, and the rate ratios for adverse events within 30 day vs. 31–90 day risk periods after treatment initiation. Related Articles