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MTX & Mouth Ulcers

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Hello Everyone,

I've been reading through posts discussing MTX and related mouth

ulcers and still have some questions. 8]:-)

I've been on MTX about 18 months -- on Enbrel injections about 15

months and just recently began developing ulcers that did not heal by

themselves.

I've been instructed to stop the MTX until all ulcers are healed. My

rheumy decreased the MTX dose from 5 to 4 tablets per week and

increased the folic acid from one to two mg tablets per day due to the

MCV imbalance but to take any more than that. Her nurse said that

ulcers usually show up in the first weeks of MTX therapy rather than a

year later.

She prescribed Kenalog dental paste and my PCP suggested oral

benzocaine for the discomfort. Some of my most uncomfortable ulcers

are where mouth and throat join -- where I can barely reach with the

paste (which helped, BTW).

She tells me that the folic acid is increased only to get the MCV

values back within normal limits and does NOT have anything to do with

healing ulcers.

Now I'm confused big time because.

Would someone explain to me the mechanics of how MTX causes these

ulcers, please? What's to say they don't form on other mucosal tissue

elsewhere in the body? Although I've been off MTX for 3 weeks, I can

still feel a strange tenderness in my mouth just before the tissue

erupts; sometimes the ridges in the roof of my mouth just swell for

several hours after this 'feeling' and then recedes. Are there other

suggestions for easing the discomfort or reducing symptoms?

Many thanks to everyone on the list for your helpfulness over the years,

Patty in an unusually mild winter in the Pineywoods of East Texas

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