Wound management when taking methotrexate: Has anyone... - NRAS

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Wound management when taking methotrexate

Sallysuk profile image
10 Replies

Has anyone else been told to stop their medication when a wound is not healing?

I cut my lower leg a month ago and it was not healing as normal so I dared to phone my GP for advice and was told after they viewed a photo that it was not infected but would take a time to clear up. Two weeks later I had my 6 monthly phone consultation with rheumatology nurse specialist who advised I stop the methotrexate and sulfasalazine for two weeks as the wound was no better and quite painful, they wanted to avoid a leg ulcer and the meds could inhibit healing. Ten days later the wound has nearly gone only a tiny scab and the rheumatology helpline nurse has recommended a bit longer then start the tablets once more.

Why did my GP not advise me to stop the tablets, it makes me question their knowledge of the the drugs I take!

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Sallysuk profile image
Sallysuk
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10 Replies
helixhelix profile image
helixhelix

GPs are general practitioners. They only have about 3 days training on rheumatology, and if they don’t have many patients with inflammatory arthritis will only have limited knowledge/experience. So you can’t expect them to know everything about everything. But they should know when to seek advice elsewhere and leg wounds, especially in elderly people, can be a red flag!

Your specialist nurse was quite rightly being extra careful. Which is great so hope now all aorted.

Neonkittie17 profile image
Neonkittie17 in reply to helixhelix

I am lucky HH, as my GP trained in the hospital rheumatology department for 6 months after she qualified. As you say though not many GPs have that experience.

Sallysuk profile image
Sallysuk in reply to helixhelix

Thanks for your reply and I will know for next time. I do not expect GP's to know everything but hoped they would be a bit more careful with methotrexate patients as this drug is used for several other conditions other than RA.

Ferret18 profile image
Ferret18

Hi, I had a minor burn to my hand recently and it’s been a devil to heal. I never even thought my meds could have been the issue - I put it down to having low WBC and neutrophils, but I guess the Sulphasalazine and/or others could have played a part.

nomoreheels profile image
nomoreheels

Unless you're fortunate, or have sought out, & have a GP who has a Special Interest in Rheumatology (GPwSIR - taken further training & qualifications) then their knowledge of RD meds is rudimentary. Whilst it's true having shared shared care means he takes on safe use of meds his knowledge of specialised ones (those initially prescribed by a Rheumy) is limited. In this instance I would have hoped he'd have directed you to Rheumatology, but you know now for next time. As it is it was fortunate you had your 6 monthly Nurse Specialist review so received advice, but you'll know another time. I'm pleased the wound is healing & hope halting your MTX & SSZ hasn't caused disease activity to creep back in. Shouldn't be long before you can start that again I hope.

Sallysuk profile image
Sallysuk in reply to nomoreheels

Thanks for comment and I will certainly remember for next time. My hands and wrists are not as good as usual but that may be my imagination or osteoarthritis which I also have.

crashdoll profile image
crashdoll

Hi Sally, I have a skin condition that causes ulcers and I had a problem with one that was refusing to heal. I got the impression it was a bit complicated for the GP so probably best to liaise with rheum for stuff like this. That said, GP should have some awareness of methotrexate and it’s effect on healing. Wish you well.

HamHammy profile image
HamHammy

The advice you got from your rheumy is spot on I think to stop taking methotrexate if there is an open wound. Eg when I had an open wound from visiting the dentist I stopped. Your GP wont b a specialist on the subject is what I am thinking on advice given on that one

trevo profile image
trevo

Hi Sally, I've had my methotrexate reduced by 50% to 10mg weekly and also take 40mg adulumimab fortnightly. Whenever I have had sinusitis (very rarely nowadays) or have to take prescribed antibiotics (also very rarely) I have stopped all other meds. It seems to work. Recently, due to being out of the country and Covid 19 etc, I have stopped all meds for 3 months and remained pretty good for 10 weeks. I've returned a week ago and took my first meds last week. I am still here, so it's just to say that I have found that it's possible to stop these medications every once in a while. Stay safe.

rosie1928 profile image
rosie1928

Yes, I had an open wound and went off methotrexate for nearly a year. I had a compound fracture of the ankle. Healed very well.

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