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Article
September 2, 1988

Rheumatoid Arthritis Refractory to Standard Therapy-Reply

Author Affiliations

National Institute of Arthritis, Musculoskeletal and Skin Diseases Bethesda, Md

National Institute of Arthritis, Musculoskeletal and Skin Diseases Bethesda, Md

JAMA. 1988;260(9):1241. doi:10.1001/jama.1988.03410090069024

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Abstract

In Reply.—  I thank Dr Nordstrom for noting the error in my article. He is absolutely correct that azathioprine must be reduced to about 25% of the usual dose when used with allopurinol. As noted in my article, the two drugs should probably not be used together. With regard to methotrexate, I do not think there is disagreement. Methotrexate therapy generally is discontinued temporarily when serum liver enzyme levels are elevated twofold to threefold. Once the serum enzyme levels normalize (unless other contraindications exist), drug therapy can be reinstituted, as indicated in my article, usually at a lower dose. One does not disregard elevations in serum liver enzyme levels just because they do not correlate with histopathology.

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