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MTX Wound Healing — SCE Rheumatology MCQ

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EasyRheumatology PharmacologyMTX Wound HealingSCE Rheumatology

A 35-year-old woman with RA on Methotrexate requires dental work. She asks whether Methotrexate affects wound healing. What is the evidence?

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Correct answer: D — At rheumatology doses (7.5-25 mg weekly) Methotrexate does not significantly impair wound healing for minor procedures including dental work and can be continued perioperatively for minor surgery

At the low doses used for rheumatic diseases (7.5-25 mg weekly) Methotrexate does not significantly impair wound healing for minor procedures. BSR 2019 biologic safety guidelines and perioperative guidance recommend continuing Methotrexate for minor surgery and dental procedures as stopping it increases the risk of disease flare without meaningful wound healing benefit at these doses. For major surgery (joint replacement extensive soft tissue surgery) the evidence is less clear but most rheumatologists continue Methotrexate as two RCTs showed no increase in wound complications with continuation versus interruption.

Reference: BSR 2019 biologic safety guidelines; Grennan DM et al 2001 MTX perioperative RCT