Answering Methotrexate Questions

Are more questions about the medication methotrexate popping up lately? It’s not surprising since a recent study indicates a link between this medication and an increase risk of liver damage in patients with psoriasis.

Methotrexate continues to be a frontline treatment for autoimmune diseases, including psoriasis. It suppresses inflammation by dampening the body’s immune response.

Psoriasis is already associated with a higher risk of developing liver trouble (regardless of which medication a patient takes), but the combination of psoriasis and methotrexate can increase the odds of liver disorders even more. In fact, the psoriasis-methotrexate combo doubles the risk of liver disorders developing.

This is a legitimate concern; however, it can be managed. For example, patients with additional liver disease risk factors – including obesity or regular alcohol use – can be counseled to make necessary lifestyle changes to more safely use this medication. In addition, changing treatment to a different medication for psoriasis can introduce other risks (e.g., non-steroidal anti-inflammatory drugs (NSAIDs) can also damage the liver).

The takeaway: For anyone starting or continuing to take methotrexate, the most important thing to keep in mind is that you should make and keep an appointment with your health care provider to get a simple lab test that will check your liver function.

Sidebar: The 1-2-3 Psoriasis Treatment Approach

Here’s a common course of action when first treating psoriasis:

  1. Application of topical creams and ointments, such as corticosteroids, vitamin D analogues, anthralin, topical retinoids, calcineurin inhibitors, salicylic acid, coal tar, and/or a moisturizer.
  2. Skin exposure to natural or artificial ultraviolet light. The light causes the activated T cells in the skin to die, which slows down the cell turnover that is a problem in psoriasis. Limit sun exposure to avoid sunburn.
  3. Oral medications or injections of medications, including methotrexate, retinoids, cyclosporine, hydroxyurea, immunomodulating drugs (such as Humira, Stelara, or Enbrel), and thioguanine.


Rapaport L. Psoriasis tied to higher risk of serious liver disease. Reuters November 10, 2017.

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