Frequently asked questions
For patients taking Disease Modifying Anti-Rheumatic Drugs (DMARDS)
1. I am having a flare of my arthritis, what shall I do?
Use maximum pain relief regularly, such as Paracetamol and anti-inflammatory drugs i.e. Ibuprofen, if you think you are experiencing a flare of your disease. Ask your GP if you need something stronger if these medications do not help. Resting the joint or joints and using ice/heat packs can be helpful. If this does not improve your symptoms over a few days, have a blood test and contact the Rheumatology Advice Line. There is useful information about managing symptoms on the Versus Arthritis website.
2. Can I take anti–inflammatories with methotrexate?
Yes, the combination of methotrexate and anti-inflammatories is considered safe. There are some contraindications with other medications, if you are unsure contact the rheumatology team.
3. I think I am having side effects from my medication, what should I do?
All medications can cause side effects. With regards to Methotrexate, nausea, mouth ulcers and a dry mouth are common side effects. Increasing folic acid up to 6 days a week, and taking anti-sickness medication is likely to help these symptoms. Shortness of breath and/or a dry cough may require further investigation as rarely these can be due to methotrexate. It is important to report any side effects, even those not listed. Seek advice from the Rheumatology team by contacting the Advice Line if you are concerned.
4. Should I have the flu and /or the pneumonia jab?
We recommend both the 'flu and pneumonia vaccines in patients with rheumatological conditions, particularly for those patients on disease modifying anti rheumatic drugs [DMARDS] e.g Methotrexate, Sulfasalazine, Leflunomide and biologic therapies.
5. Can I have vaccinations while I am on my rheumatology medication?
You should avoid live vaccines such as oral polio and yellow fever while on any immune system suppressing medication such as methotrexate, sulfasalazine, Leflunomide, Etanercept, Adalimumab (etc). If you are likely to require vaccinations we would suggest discussing this with your GP well in advance of any travel dates. Further information about vaccinations is available from Versus Arthritis.
6. I am having an operation what do I do with my medication?
Although it is safe to continue all DMARDs during the time of an operation, they may be stopped at the discretion of the surgeon and after discussion with the rheumatology team looking after you. Oral steroids [Prednisolone] should be taken at the lowest dose possible to reduce the risks of infection and delayed healing. Do not stop steroid tablets abruptly. Do not increase or reduce your dose without consultation with your GP or Rheumatology team. Biologic medication should be stopped before and after surgery under the advice of your Rheumatology team. Please seek advice from the Rheumatology Advice Line on how to do this.
7. I have an infection/ I am on antibiotics; do I need to stop my medication?
DMARDs may take up to 3 months to work, so stopping them for 1-2 weeks is unlikely to lead to a flare of your arthritis, it is not always necessary to stop but always seek advice if you are uncertain. Biologic drugs should always be stopped if you have signs of an infection and re-started once the infection has cleared/antibiotics finished. Trimethoprim and co-trimoxazole [Septrin] must never be taken with Methotrexate.
Steroid tablets should never be stopped during an infection, and instead on occasions the dose of steroids may need to be increased please discuss this with your doctor if you are unwell enough to be confined to your bed, or if you've been admitted to hospital.
8. How do I find out the results of my tests?
Patients on immune suppressing medications need to have regular blood tests to make sure that the drugs are being used safely. We will contact you if they are abnormal, otherwise these will be discussed at your next appointment, unless a clinician has asked you to call the Rheumatology Advice Line for them. Copies of your blood tests are automatically sent to your GP and many patients can access their results directly in an online service from their GP.
9. Why have I not received my prescribed biologic medication?
To ensure all prescriptions for biologics can be generated without delay, please ensure you have your blood tests as agreed with your Rheumatology team instructions. Please also ensure you attend all your Rheumatology department appointments, this will allow us to process your repeat prescriptions and avoid delay. Your prescription may not be renewed if you do not have your blood tests as instructed.
10. Is it OK to use complementary or herbal remedies?
Some people derive benefit from complementary or herbal medicines, but there can be significant interactions with prescribed medications. If you wish to use these therapies please discuss this with your Rheumatology team. Further information may be obtained from Versus Arthritis.
11. What happens if I or my partner gets pregnant whilst taking disease-modifying treatments?
You may need to discuss your medication prior to planning for a family. Some DMARDs are known to be potentially harmful to an unborn child and it is important to notify us via the Rheumatology advice line immediately if you become pregnant on treatment. We will advise you if it is safe to continue with treatment or discuss possible alternatives.
12. What should I do if I come into contact with someone with chicken pox whilst on methotrexate?
Notify the Advice Line or your GP as soon as possible as you may need treatment with anti-viral medication (aciclovir) to minimise the severity of the disease.
13. Can I have the shingles vaccine?
You will need to check with the Rheumatology Advice line as this will depend on what medication you are on and if you have had previous chicken pox. Up until recently all Shingles vaccines have been 'live' and so are avoided in those on immunosuppressants, however, newer (non-live) vaccines have recently become available – please discuss with your GP.
14. I might have shingles, what should I do with my rheumatology medication?
You will need to stop your immune system suppressing medication such as Methotrexate, Leflunomide and Biologic medication and make an urgent appointment with your GP for treatment with aciclovir.
15. Why do I need to take folic acid with methotrexate each week?
Folic acid reduces the side effects of methotrexate such as nausea and mouth ulcers. If these are severe you may be advised to take folic acid more frequently and will be prescribed by your GP. Over the counter folic acid is a different dose to the required dose used in rheumatology.
