Rheumatology Expert Opines on Methotrexate Toxicity

Joseph O'Neill

Written by
— Updated on November 21, 2017

Rheumatology Expert WitnessThis case involves an elderly male patient who presented to a rheumatology clinic for treatment of rheumatoid arthritis. The patient was placed on a regimen of methotrexate and instructed to visit the clinic on a monthly basis for follow-up. The patient was monitored by the clinic for one month before his dosage was increased. Despite the ongoing monthly follow-ups at the rheumatology clinic, no lab testing was performed. Eventually, the patient was admitted to the hospital with a variety of symptoms related to methotrexate-induced pancytopenia.

Question(s) For Expert Witness

  • 1. How often do you treat patients suffering from RA with methotrexate?
  • 2. What is the standard of care for monitoring patient's labs and levels on methotrexate?

Expert Witness Response E-001209

I have extensive experience administering, and monitoring, methotrexate as a treatment for rheumatoid arthritis. About 60-70% of my patients receive this treatment. While methotrexate is commonly used, its potential toxicity is well known and so lab guidelines should be followed stringently. Typical standard of care under these circumstances calls for labs every 4 to 8 weeks.Even an otherwise healthy and stable patient should only go 12 weeks between labs. However, as this patient was both elderly and showed signs of renal failure she was at higher risk for toxicity than the average patient and labs should have been taken within that 4 to 8 week period, preferably even more frequently. Failure to perform labs regularly while a patient is on methotrexate is a massive breach in standard of care. This should not have happened and I believe that the plaintiff has a strong case.

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