Methotrexate intolerance in the treatment of rheumatoid arthritis (RA): effect of adding caffeine to the management regimen

Abstract

The aim of this study was to investigate the effect of caffeine on the symptoms of methotrexate (MTX) intolerance in patients with RA. The follow-up patients with RA seen over a period of 11 months were included in this work. The degree of MTX intolerance, if present, was classified as ‘moderate’ and ‘severe’. Those with intolerance were advised caffeine (coffee or dark chocolate) synchronised with the MTX dose. The effect was assessed as ‘very good’, ‘good’ or ‘none’. Among 855 patients seen during this period, 313 (36.6 %) did not have any MTX intolerance, 542 (63.4 %) patients had some degree of MTX intolerance, 422 (77.8 %; 49.3 % of the total patients) had ‘minimal’ intolerance not requiring any intervention. The remaining 120 (22.1 %) of the 542 (14 % of the total 855) patients had ‘moderate’ or ‘severe’ MTX intolerance. Among these, 55 % had complete relief of symptoms and were able to continue taking the advised dose of MTX; 13.3 % had partial improvement and continued taking MTX but only with antiemetics; 7.5 % were minimally better but were somehow managing; 10 % were complete caffeine failure without any relief; 14.2 % did not like caffeine (coffee or dark chocolate) and did not want to take it. Caffeine relieved the symptoms of MTX intolerance in 55 % and partial relief in 13 % of the patients. A significant number of patients did not like to take caffeine (coffee or dark chocolate). It is of note that northern part of India is primarily a tea-drinking population where coffee is not a favourite drink.

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Fig. 1

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Acknowledgments

I would like to express my sincere thanks to Dr. S. B. Gogia, MS (Surgery), Consultant General Surgeon and, Plastic and Hand Surgeon; Healthcare Informatician Sanwari Bai Surgical Centre, 28/31, Old Rajinder Nagar, New Delhi, for help in statistical analysis and in making the Fig. 1 for this paper. My sincere thanks are also due to Ms. Roopa Rawat, Specialist Rheumatology Nurse and Ms. Pinki Negi, BA, Medical Secretary, ‘A&R Clinic for Arthritis & Rheumatism’ and Department of Rheumatology, ISIC Superspeciality Hospital, Vasant Kunj, New Delhi - 110070, INDIA for their unstinting help; former for suggesting the possibility of using dark chocolate as a coffee substitute and the latter for arranging telephonic interviews with the patients, and in data entry.

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Correspondence to Anand Narayan Malaviya.

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Malaviya, A.N. Methotrexate intolerance in the treatment of rheumatoid arthritis (RA): effect of adding caffeine to the management regimen. Clin Rheumatol 36, 279–285 (2017). https://doi.org/10.1007/s10067-016-3398-3

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Keywords

  • Adenosine
  • Caffeine
  • Coffee
  • Intolerance
  • Methotrexate
  • Methylxanthines
  • Rheumatoid arthritis