From the Guidelines
Methotrexate for gout inflammation is typically prescribed at a dose of 15-20 mg once weekly, taken orally, with a starting dose of 15 mg weekly and escalating fast with 5 mg/month to 25–30 mg/week if needed based on clinical response, as supported by 1. The treatment should be taken on the same day each week, and many physicians recommend taking folic acid supplements (1 mg daily) on the non-methotrexate days to reduce side effects, as folic acid reduces gastrointestinal and liver toxicity without reducing efficacy, as shown in 1. Methotrexate works as a disease-modifying anti-rheumatic drug by inhibiting dihydrofolate reductase, which reduces inflammation and prevents recurrent gout attacks. Some key points to consider when prescribing methotrexate for gout inflammation include:
- Starting with a dose of 15 mg/week and escalating to 25-30 mg/week if needed, as this dosing strategy is associated with higher clinical effect sizes, as seen in 1
- Using oral methotrexate, as it is widely preferred due to patient preferences and low costs, although parenteral methotrexate may be considered in cases of insufficient response, as suggested in 1
- Monitoring complete blood count, liver function, and kidney function regularly during treatment, as methotrexate can cause toxicity, particularly at higher doses, as noted in 1
- Avoiding alcohol while taking methotrexate due to increased risk of liver toxicity, and informing patients that the medication may take several weeks to reach its full therapeutic effect, as methotrexate should not be used during pregnancy or when planning conception. The optimal evidence-based dosing strategy seems to be starting with 15 mg/week and escalating fast with 5 mg/month to 25–30 mg/week, although this should always be individually adapted to the level of disease activity and tolerability, including renal function, as recommended in 1.
From the Research
Dose and Frequency of Methotrexate for Gout Inflammation
- The provided studies do not directly address the dose and frequency of methotrexate for gout inflammation 2, 3, 4, 5, 6.
- However, methotrexate is mentioned as a treatment option in one of the studies, but it is in the context of primary biliary cirrhosis, not gout 6.
- The other studies discuss various treatment options for gout, including nonsteroidal anti-inflammatory drugs, colchicine, corticosteroids, and interleukin-1 inhibitors, but do not mention methotrexate as a treatment for gout inflammation 2, 3, 4, 5.
- Therefore, there is limited information available on the dose and frequency of methotrexate for gout inflammation based on the provided studies.
Alternative Treatment Options for Gout Inflammation
- Nonsteroidal anti-inflammatory drugs, colchicine, and corticosteroids are commonly used to treat acute gout inflammation 2, 3, 4, 5.
- Interleukin-1 inhibitors, such as canakinumab, are also effective in reducing pain and risk of new gout attacks 3.
- Urate-lowering therapies, such as allopurinol and febuxostat, are used to manage chronic gout by reducing serum urate levels 4, 5.