My experience with methotrexate black box warning: soft tissue necrosis.

There is another dilemma to face when you have rheumatoid arthritis. I was surprised by this one. After all, I have had RA for seven years and feel I have covered a lot of ground in that time. I know infection posed a very high risk while taking RA meds. My mind thought flu or maybe pneumonia.

Suddenly and out of the blue, my right breast developed a lesion and stated to drain. I felt feverish and went to see my oncologist who sent me to the breast surgeon oncologist down the hall because she was the one who had the ultrasound machine. She came in, introduced herself and looked at my lesion. She instantly knew that it was caused by necrotic breast tissue due to radiation for breast cancer. The radiated tissue gradually degenerates, expands until it pushes through the delicate breast skin and drains. It cultured positive and I was sent to the wound clinic.

Eventually, it was determined that the only solution was a partial mastectomy. That done and a week later, I developed a severe infection and cellulitis. The incision had popped open and sprung a leak. I was treated with antibiotics. I was again sent to the wound clinic. The nurse debrided the wound.  I was instructed on packing the wound (deep) with iodophor. Eventually, the drainage lessened. The iodophor packings were stopped. Inserting cellulose/collagen/silver slices were started. Progress is being made.

Now for the RA dilemma. Both oncologists insisted I stay off methotrexate. They felt if I would continue methotrexate, I would have a repeat of breast necrosis. The radiated tissue will always be problematic, but the methotrexate will make it worse. I agreed. No more methotrexate. I didn’t want to have to deal with another wound for another ten months.

Soft tissue necrosis is black box number thirteen for methotrexate.

I had been on methotrexate for seven years. Initially, I suffered through the usual side effects, but over time the symptoms disappeared especially once I started taking methotrexate by injection. It helped keep me even. I still had problems, but my base line was much better. Now I am having worsening flares.

The difficult part for me is that I have many joints affected. In a flare with all of the joints spewing inflammation factors, I start feeling sick. It feels like a flu. So, in addition to joint discomfort, my whole body feels ill.

This complication took ten months to heal. The ten-month ordeal was caused by a combination of factors. I had radiated breast tissue which normally has poor circulation. In addition, I was be medicated with injections of methotrexate. Soft tissue necrosis was the thirteenth black box warning of methotrexate.