Calvin and Hobbes, Carrie Mathison, Donald Draper, Dr. Who and… Methotrexate. Dynamic and perplexing, they sure grab your attention. But, are they good or bad?
The best answer is both. Do you want them in your life? Hmmmm. And, how are these complicated types going to impact you if they are in your life?
When you’re dealing with the gray areas of your rheumatoid arthritis (RA) treatment, and there’s often a lot of gray, the best thing you can do is continue to gather information and develop your decision-making skills.
Just like a well-developed character, Methotrexate is complex and not easily categorized into specific category. “Of Course!” or “Ewwww, No Thanks!” don’t apply.
What is Methotrexate?
A chemotherapy agent and immune system suppressant, Methotrexate was first developed in 1947.
It was initially used for cancer treatment. Since then, it’s also commonly prescribed for autoimmune disorders, including rheumatoid arthritis.
Methotrexate is prescribed as Rheumatrex® or Trexall®. They’re considered DMARDs (disease-modifying anti-rheumatic drugs).
Methotrexate is one of the mainstays of treatment for inflammatory forms of arthritis, including rheumatoid arthritis (RA) psoriatic arthritis and juvenile idiopathic arthritis, because it not only reduces pain and swelling, but it can actually slow joint damage and disease progression over time.
That’s why methotrexate is known as a disease-modifying anti-rheumatic drug (DMARD). – Arthritis Foundation
RA patients hear the acronym DMARD all the time. The mechanisms of that class of drugs are not the same. They’re merely categorized together because they modify the disease.
In other words, DMARDs all work to slow or halt the progression of joint damage, but they work differently in your body. Methotrexate is considered a DMARD and immunosuppressant.
When you have cancer, it works by inhibiting the growth of malignant (cancerous) cells by starving them of nutrition. By blocking the cells ability to absorb folate, a type of vitamin B, the cells starve.
Cancer and RA are very different. How methotrexate improves the health outcomes for RA patients isn’t entirely understood.
Nonetheless, rheumatologists (RA doctors) find that it suppresses, and possibly improves, the immune system function for those with RA.
Methotrexate as a First Line of Defense
If you’ve been diagnosed with moderate to severe rheumatoid arthritis, it’s likely that your rheumatologist has either discussed or prescribed methotrexate.
While it’s been around since the 1940s, it wasn’t until the 1980s that physicians discovered its efficacy for autoimmune arthritis. It’s now considered a first line of defense for RA.
Approximately 90% of RA patients are prescribed methotrexate at some point.
Methotrexate typically comes in 2.5 milligram (mg) tablets. Adults with rheumatoid arthritis usually begin with a starting dose of 7.5 to 10 mg, or 3-4 pills, taken all together once a week.
The dose may be increased to 20 to 25 mg a week over time if needed. – American College of Rheumatology
Results are seen fairly quickly. Patients typically notice improvements after three to six weeks. Pain and swelling dissipate in many cases.
However, methotrexate alone doesn’t work for everyone. It can be used in combination with other DMARDs, such as leflunomide.
More still, if DMARDs are not effective, methotrexate can be prescribed in conjunction with a class of drugs called biologics (they target a part of the immune system responsible for an inflammatory response).
Methotrexate: The Good
- One of the most effective and commonly used RA drugs
- Reduces pain and swelling
- Slows the progression of arthritis over time
- Improvements are first seen in three to six weeks
- Long history of data
Methotrexate: The Bad
- Can cause nausea or vomiting
- Abnormal liver function tests, possible liver cirrhosis
- Lung problems: persistent cough or shortness of breath
- Hair loss
- Can cause birth defects
Like prescriptions in general, most don’t experience all the negative side effects. And, on the other end of the spectrum, most do experience the benefits of methotrexate.
Why Methotrexate and Life Insurance Have a Difficult Relationship
Life insurance companies are data and risk driven. Picture a big calculator. When someone applies for life insurance, the company gathers and processes their information (data) to determine how much risk he or she poses.
When your data is entered into a life insurance company’s big calculator, your methotrexate prescription is considered a risk.
Why? Even though it can potentially benefit your quality of life and improve your health outcomes, the fact that you need to take the drug is concerning to their big calculator.
Let’s put a magnifying glass on a couple of methotrexate examples:
- Elsa was diagnosed with RA two years ago. She takes NSAIDs (non-steroidal anti-inflammatory drugs) and methotrexate regularly to manage and improve her symptoms. Elsa’s finger and knee joints are affected. Her organs are not affected. Elsa leads an active life and is not disabled. Elsa qualified for Rated Standard life insurance. In other words, Elsa was approved for traditional fully-underwritten life insurance. She also needs to pay a surcharge on her premiums because she is rated. Surcharges, also known as table ratings, vary depending on the life insurance company and the level of rating. For every $1.00 in base premium charged, a certain percentage is added depending on what table you are assigned. Consider the following general guidelines. Rates and surcharges vary with life insurance companies.
- Table 1 or A = 25% surcharge = $1.25
- Table 2 or B = 50% surcharge = $1.50
- Table 3 or C = 75% surcharge = $1.75
- Table 4 or D = 100% surcharge = $2.00
- Table 8 or H = 200% surcharge = $3.00
- Anna was diagnosed with RA 12 years ago. She continually takes methotrexate and a TNF (tumor necrosis factor) inhibitor. Occasionally, Anna is prescribed prednisone to control flareups. Anna is disabled due to deformity in her toe joints from RA. She is unable to work. Anna has been diagnosed with atherosclerosis and lung nodules. Anna received a Decline and did not qualify for traditional fully-underwritten life insurance. However, Anna didn’t despair! She quickly met with an agent who is an expert in rheumatoid arthritis to discuss whether or not a Graded Benefit Life Insurance policy made sense. Anna knows there are always life insurance options available to protect her family.
Methotrexate isn’t the only thing life insurance companies pay close attention to.
Other Things Life Insurance Companies Want To Know About You
Life insurance companies collect a fair amount of data to determine how much risk you pose.
Based on your application, a decision will be made on if traditional life insurance will be offered to you, and how much they will charge you for it.
In addition to your methotrexate usage, they will want to gather information on your:
- Blood/Urine samples
- Blood pressure
- Family medical history
- Personal medical history (i.e. rheumatoid arthritis, depression)
- Other Medications
For an in depth analysis of your RA and how it relates to life insurance, fill out our confidential questionnaire.
Making Peace With a Complicated Character
Calvin and Hobbes are fun but reckless. Carrie Mathison is brilliant but unpredictable. Donald Draper is creative but selfish.
Dr. Who is wise but callous. And, methotrexate can heal but hurt. In the end, it’s up to you (and your rheumatologist!) to decide whether the pros outweigh the cons.
Just like most aspects of life, your RA treatment is not a black and white matter.
Kelly, from a great rheumatoid arthritis blog called, RA Warrior describes her relationship with methotrexate brilliantly:
Finally, we ask ourselves: “Is it worth it? Will my life either be improved or extended so that the unpleasant side effects are outweighed?”
Perhaps deciding to take methotrexate is a bit like marrying a rich gorgeous-looking person who has perpetual bad breath. Not a charming thought.
When all is said and done, in my estimation, it is best to fight. And if the Rheumatoid Arthritis brings its strongest weapons, we should bring ours. Often, that includes methotrexate. – Kelly, RA Warrior
Rheumatoid Arthritis Life Insurance Experts
We specialize in working with clients with rheumatoid arthritis find the highest quality protection at the best prices available. If you have RA and are seeking out life insurance, it’s crucial to collaborate with an agent with a deep understanding of RA.
At Rheumatoid Life Insurance, our job is to be your advocate. As an independent life insurance agency, we will cross-reference the top-rated life insurance companies to find the best rate for which you can be approved.
Fill out our Instant Quote form to get started.