Methotrexate - mouth pain/ulcers


I have RA (and T1 diabetes) and currently take methotrexate, sulphasalazine and hydroxychloroquine with folic acid in support. I suffered terribly with nausea so was moved from tablets to injections in October, however I am now suffering with horrendous throat/tongue/soft palate and ear pain with ulcers. I've read a few posts on here which mentioned daily folic acid and injections as solutions but as I'm already on these does anyone have any other suggestions? Or could I possibly be at the end of the road with this current therapy combination?

I know there are no magic answers but I'd appreciate any shared experiences. My pain isn't even under control so I'm feeling pretty miserable at the moment.

Thanks in advance x

11 Replies

  • Hi. Try rinsing mouth several times a day with salty water, avoid toothpaste containing SLS (sodium lauryl sulphate) and try eating pineapple. Good luck.

  • Hi, I switched from mtx to leflunomide around a year ago and have not had the mouth ulcers since. So there may be an option for you if mtx no longer the right drug. Best of luck

  • I came off methotrexate mainly because of the enormous mouth ulcers that I had (and the diarrhoea, sickness, brain fog, etc).

    I'm now on azathioprine, no mouth ulcers (well small and rarely), still upset stomach (but a lot less) and no brain fog. The control of the inflammation is much the same, not brilliant but sufficient.

  • "Not brilliant but sufficient". Very much sums me up too which is rubbish really.

    I have GP appt today for what I suspect is now a quite infected mouth/throat and waiting for a call back from my Rheum nurse regarding my mtx.

    If it left me pain free it might at least make all the side effects worth it.

  • I too also take the same medication as yourself since September 2016. My arthritis creates mouth ulcers as well as methotrexate medication. Yes they are painful and annoying. My tongue just cannot leave them alone. Trying eating salty crisps or salt and vinegar. That sometimes helps me. Good luck in trying x

  • I take two folic acid pills on the day of injection, and one other days. But still I get them, just not as bad. I use Orajel mouthwash for mouth sores and orajel medicine for mouth sores. Oragel really does help.

  • Hi, I was advised not to take folic acid on the day of the Injection, but take it the other 6 days? I have my Injection Wednesday nights and usually feel dreadful most of Thursday but don't take folic acid till Thursday night.

  • Saline - warm water + salt 5 times a day for 48hrs got rid of my mouth ulcers.

    Basically I take my MTX on a Monday evening, come Wed I feel the first tingle from the ulcers, by Fri back to normal again.

    I found just leaving the saline in my mouth for 2 mins rather than rinsing worked for me.

    All thanks to my local Pharmacist who told me this is very common and don't waste money on more drugs.

  • Thanks everyone. Turns out I have the equivalent of tonsillitis (despite the fact I had my tonsils out 10yrs ago)! So I'm hoping the current mouth ulcers are linked to that inflammation rather than my methotrexate. But it does mean missing it for a week or two. I won't miss the injections but it makes me nervous in case of a flare. It's all such a juggling act!

  • You could try Chlorhexidine Gluconate Antiseptic Mouthwash. I used it a few months ago when I got my first ever mouth ulcer (who knew mouth ulcers were so bloody sore!), and it really helped to clear it up. I just bought it in Sainsburys. Also dab Anbesol on affected area (if you can reach it) just before you eat or drink. Totally numbs the area and makes eating/drinking a bit more bearable.

  • I have been taking MTX for my RA for about a year and have had severe canker sores the whole time. I tried everything from oral numbing gel to salt water to hydrogen peroxide to prescribed "Magic Mouthwash". Absolutely nothing helped to alleviate the pain for more than maybe 30 minutes. Then, I found "Canker Covers", made by DenTek. These things are an absolute godsend! They actually stick onto the sore to keep it protected from bacteria and irritation. And they stay on for hours! 12 bucks is sooooo worth the relief! I hope this helps someone else who has been as miserable with mouth sores as I was!

You may also like...