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.
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
Studies on corticosteroids tend to lean toward the extreme use, rather than the average use. For example, some studies look at corticosteroids for extreme and rarer cases of eczema. This makes it harder to research what long-term studies are out there on steroid use. To complicate things further, corticosteroids can be oral, topical, injected, or inhaled, and this dramatically changes the benefits and risks, and in turn the short-term and long-term effects. Speak with your doctor and pharmacist on what, if any, long-term studies out there are relevant to your own medical treatment.