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Tingling and Numbness: Is It a Side Effect of Methotrexate for RA?

Posted on June 22, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Caroline Wallace, Ph.D.

Rheumatoid arthritis (RA) is an autoimmune condition that causes inflammation in your joints and organs. In addition to painful, swollen joints and stiffness, symptoms such as tingling and numbness can occur with RA. Up to 20 percent of people living with RA experience nonjoint symptoms in their nerves, skin, eyes, lungs, heart, kidneys, blood vessels, and bone marrow.

Members of myRAteam report painful tingling and numbness. As one myRAteam member wrote, “It’s so good to know I’m not alone and that my pain is not all in my head.”

Because both RA and some medications used to treat RA may cause tingling and numbness, you may be wondering why you are experiencing these uncomfortable sensations.

Use of the Drug Methotrexate in RA

If you are living with RA, you may be familiar with the commonly prescribed disease-modifying antirheumatic drug (DMARD) methotrexate. This drug is an immunomodulator — it changes your immune system to reduce the damaging inflammation.

Methotrexate was originally used to treat some forms of cancer, which has led to the common misconception that methotrexate is highly toxic. The methotrexate doses used in people living with RA are much lower than the doses given to people with cancer. This DMARD is also used to treat other autoimmune conditions such as psoriasis, psoriatic arthritis, and juvenile idiopathic arthritis.

Common Side Effects of Methotrexate

Although methotrexate is an effective medication for people with RA, it can produce some unwanted effects. The most common side effects include:

  • Stomach pain, diarrhea, nausea, or vomiting
  • Oral problems such as bleeding gums or sores in the mouth or lips
  • Itchy or discolored skin or pinpoint red spots
  • “Methotrexate fog,” such as headaches, fatigue, and feeling unwell

Like all medications, methotrexate may cause a wide range of side effects. Be sure to tell your health care provider or rheumatologist if you experience side effects from your prescribed medications.

Serious Side Effects of Methotrexate

Methotrexate can occasionally cause serious, potentially life-threatening side effects such as an allergic reaction. You should contact your doctor right away if you experience itching, skin rash, trouble breathing, irregular heartbeat, or dizziness.

Other rare but possible side effects include liver damage, lung disease, and lower blood counts. People taking methotrexate are at increased risk of serious infections, so it’s important to practice good hand hygiene and dental care and be careful when shaving.

Methotrexate is also not appropriate for use during pregnancy. Individuals taking methotrexate should use a reliable form of birth control.

Can Tingling and Numbness Be a Side Effect of Methotrexate?

Rarely, the drug methotrexate may cause problems with nerves. One symptom of this side effect is tingling and numbness in your hands, feet, or lips.

Methotrexate blocks your body’s ability to use the vitamin folate, which is an essential nutrient. Low levels of folate can cause tingling and numbness, as well as other nerve-related problems. For example, a case report described optic neuropathy (blindness caused by a nerve problem in the eye) from low-dose methotrexate use. The side effect was reversed by administering folate (seen as folic acid on supplement bottles).

Folic acid is often used to alleviate various side effects of methotrexate, including fatigue, headache, and stomach problems.

If you are taking methotrexate and develop tingling, numbness, or other signs of a problem with your nerves, notify your health care professional immediately for medical advice. Numbness and tingling may be signs of serious side effects, which can often be corrected if promptly treated.

Tingling and Numbness From RA

Another cause of tingling and numbness in people living with RA is peripheral neuropathy. This condition is caused by damage to the peripheral nerves (outside of the brain and spinal cord).

Peripheral neuropathy may cause:

  • A prickling feeling in the skin
  • A pins-and-needles sensation
  • Painful or unusual sensations
  • Muscle weakness
  • Extreme sensitivity to touch

Some people living with RA may develop mild forms of peripheral neuropathy. As the nerve damage progresses, a person may feel numbness, tingling, and weakness of the hand, wrist, and arm. In people living with RA, the symptoms generally appear symmetrically — on both sides of the body — and may be felt in the upper or lower limbs or both. Because these symptoms may overlap with other RA symptoms, it is difficult to determine which condition is causing the numbness and tingling.

How To Deal With Tingling and Numbness

If your tingling and numbness are caused by RA (and not the medications), your health care provider may prescribe a drug to help relieve the symptoms. To prevent dangerous drug interactions, be sure to let your doctor know about all your medications to prevent dangerous drug interactions.

Certain therapies and procedures, including physiotherapy and assistive devices, transcutaneous electrical nerve stimulation, and surgery, may help relieve the problems caused by tingling and numbness.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 191,000 members come together to ask questions, give advice, and share their stories with others who understand life with rheumatoid arthritis.

Have you taken methotrexate for your rheumatoid arthritis? If so, what has been your experience? Please share your story in the comments below — or start a conversation or ask a question by posting on your Activities page.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Caroline Wallace, Ph.D. has a doctorate in biomedical science from the Medical University of South Carolina. Learn more about her here.

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