The Arthritis Drug Methotrexate and Lymphoma

My mother-in-law last winter developed one of the worst cases of rheumatoid arthritis in her hands that her doctor had ever seen, so she prescribed the drug methotrexate for it in February. Methotrexate was to be taken every Tuesday, and gradually the dosage was upped. Incredibly, my mother-in-law, Claire, saw the swelling in her hands decrease and the pain begin to lessen, but unfortunately as the months passed she began to notice that she was developing lumps under her armpits. At this point my wife, who is a nurse, decided to do some research on methotrexate, and all of the drugs that Claire was being treated with for her various ailments, and was shocked to find that one of the rare side-effects of taking methotrexate can sometimes be lymphoma!

Methotraxate is used in the treatment of severe psoriasis, severe rheumatoid arthritis, breast cancer, lung cancer, leukemia, and ironically enough, certain types of lymphoma. It is in the class of meds known as antimetabolites, a drug that attempts to slow the growth of cancerous cells. It is used against psoriaisis because it has shown the ability to slow down the growth of skin cells that too quickly reproduce, and it has been used for terrible cases of arthritis, such as Claire had, since it can deter the activity of the immune system.

Claire was told it would be about six to eight weeks before her hands started feeling better due to the use of methotrexate, and right on schedule the drug began having positive effects. However, Claire was feeling tired and run down and lost about ten pounds during the spring and summer. In August, Claire discovered two egg-sized lumps under each armpit and was duly alarmed. She brought this to the attention of my wife, who quickly got her an appointment with her primary care physician. Claire underwent a mammogram, which showed that the breasts were clear of any tumors. This is when my wife went online and found that methotrexate had caused lymphoma in a very tiny percentage of those who took it, a disease whose symptoms mirrored Claire's.

The information she found also said that the lymphoma, which is a type of cancer caused by the production of abnormal white blood cells, can reverse itself if one stops taking methotrexate. My wife contacted Claire's rheumatologist and discussed this information and the doctor agreed that Claire should not take any more methotrexate. Claire stopped taking the drug and her primary care physician ordered a biopsy to determine if the lumps under her armpits were indeed cancerous and brought about by lymphoma. When she saw the surgeon for a pre-biopsy consult, she had by then developed other areas of swelling, most obviously in her neck. Her surgeon decided that rather than a needle biopsy which would have taken a small piece from one of the lumps under her armpits, he would remove an entire lymph node from the base of her neck. This was done with no problems and Claire awaited the results anxiously.

When she went to see the surgeon for her biopsy results, he told her that the preliminary findings were consistent with lymphoma in many ways but that further studying of the node would be done at another facility. He then examined Claire and found that the swelling of her nodes had indeed begun to reverse, just like what my wife had read on the internet. Her surgeon advised Claire later on that it was lymphoma, but that since it seemed to be going away that no chemotherapy was necessary at this point and that the situation would need to be closely monitored. It had only been fifteen days since Claire had been off the methotrexate, but already she had more energy and the lumps were dissipating. That good news was tempered with the fact that the drug that had worked so well for her arthritic hands was now not an option, since she had developed the lymphoma from it, and other forms of treatment will now have to be pursued.