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Rheumatology Advance Access published online on May 15, 2009
Rheumatology, doi:10.1093/rheumatology/kep101
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Review

Methotrexate, rheumatoid arthritis and infection risk—what is the evidence?

Andrew McLean-Tooke1, Catherine Aldridge2, Sheila Waugh3, Gavin P. Spickett1 and Lesley Kay4

1Department of Immunology,2Department of Microbiology, Royal Victoria Infirmary,3Department of Microbiology and 4Department of Rheumatology, Freeman Hospital, Newcastle-Upon-Tyne, UK

Correspondence to: Andrew McLean-Tooke, Department of Immunology, Royal Victoria Infirmary, Newcastle-Upon-Tyne NE1 4LP, UK. E-mail: andrew.mcleantooke{at}nuth.nhs.uk


  Abstract

Low-dose MTX administered weekly remains a mainstay in the therapy of RA. There is a belief amongst rheumatologists that RA patients taking MTX have both an increased risk and severity of infection. Here we review the published data on the risks of infection associated with the use of MTX in patients with RA and make some recommendations for managing MTX in patients with infection.

KEY WORDS: Rheumatoid arthritis, Methotrexate, Infection, Varicella zoster, Immunosuppression

Submitted 23 December 2008; Accepted 26 March 2009


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