Nose bleeds.

Hi. I’m new here. I have been diagnosed with rheumatoid arthritis and have recently started on methotrexate. I am having lots of nose bleeds. I was wondering if this is common and wether it is caused by the treatment. Does it go away ?

[oldtimer]

I can't see any reason why they should be related. I presume you are having regular blood tests and that they are OK?

Best to ask your own doctor for advice.

But if they are only small losses of blood they can often be due to the inside of the nose drying out. Using a cream (or vaseline) frequently inside the nose can prevent this.

[Hidden]

Hi there. Oddly I have nose bleeds that only started 9 years ago (I’m late 50s) when I was on MTX. I naturally wondered if there was a connection too. But since then I’ve had changing diagnosis and 4 further dmards and a 2 year spell on nothing and still I get these periods of heavy nose bleeds - often posterior ones.

I’ve seen several ENTs and am due to see another now at my rheumatolgist’s request for checks of ears, nose and throat to exclude possible rare Vasculitis called Relapsing Polychondritis - an autoimmune disease that corrodes cartilage. However previously the nose bleeds were blamed on dryness of Sjogrens - which I also have in my mix. I do have a humidifier and have long periods when my nose bleeds settle. But when my overlap connective tissue diseases are flaring as they are now - the nose bleeds return with a vengeance. I have Naseptin for sores and it does really help but it’s the posterior ones, which occasionally end up as huge clots that choke me up - I find more disturbing. It probably doesn’t help that I blow my nose often due to congestion and swelling and take antihistamine. The last ENT mentioned cauterising the burst capilliaries at the top rear of my nasal passages and also mentioned a deviated septum.

[AgedCrone]

I don't think so...I was on Mtx & not a single bleed.

Is your BP stable? Speak to your rheumy nurse.

[Hidden]

Hi I’ve been on mtx for 4 years now and I to get occasional nose bleeds can happen anytime of the day or night. Always from my left nostril. Lasts about a minute stops. Dr can’t explain it and RA specialist has no idea. Very strange!

[nomoreheels]

Hiya LaCote, welcome. If your nose bleeds are regular & you rarely had them before starting your MTX treatment or prior to having RD symptoms or diagnosis please do report it to your Rheumatology team. Note how regularly you're having the nosebleeds so they have accurate info.

With both RD itself & MTX we can have something called thrombocytopenia, or low platelet count. This basically means that your blood doesn’t clot as well as it should. Are you noticing you're bruising more easily too, or more than normal for you? As it could be due to either the immune condition itself or your treatment you should let your team know so they can record it & if they feel it's related treat it. Sometimes a course of steroids help or a change in med if they consider it is your MTX causing your low platelet count, but they’ll decide which course of action is necessary.

Keep us updated.