NSAIDs may lead to toxic effects such as gastrointestinal ulceration and bleeding. Symptoms of ulceration include dyspepsia, nausea/vomiting, abnormal pain or shortness of breath (Katzung, et.al., 2012).
Methotrexate is considered as the gold standard in management of RA. However, it is associated with myelosuppression, hepatic fibrosis and cirrhosis. Symptoms of myelosuppression include photosensitivity, rash, nausea/vomitting and shortness of breath. A fall in blood counts can occur as a result of myelosuppression and this is most common in elderly, patients with renal impairment or patients taking anti-folate drugs. If a significant drop in blood count is observed, then methotrexate should be stopped immediately (ACR clinical guidelines committee 1996,Katzung, et.al., 2012).
There are other toxic effects that occur as a result of methotrexate. These include blood disorders and are presented by sore throat, bruising, mouth ulcers. Moreover, liver toxicity can occur as a result of methotrexate and presented by symptoms such as nausea, vomiting, abdominal discomfort and dark urine (Katzung, et.al, 2012).
As already mentioned, concomitant use of methotrexate with other DMARDs such as hydroxychloroquine may reduce the clearance of methotrexate. This could lead to increased levels of methotrexate within the body which could reach toxic effects. Therefore, it is best to avoid concomitant administration of methotrexate with hydroxychloroquine. Moreover, patients taking methotrexate should be advised to minimize alcohol intake (katzung, et.al., 2012).
Sulphasalazine produce toxic effects similar to methotrexate and therefore present similar toxic effects. In addition, sulphasalazine can result in blood dyscrasias particularly within 3-6 months of treatment. Signs of blood dyscrasias include bruising, unexplained bleeding, sore throat, fever or malaise. Patients should be advised to immediately report these signs to a healthcare professional (Walker and...