A shortage of an injectable version of the drug methotrexate has been all over the news in 2012, sparking outrage and concern on behalf of children with a certain type of leukemia who can’t get their life-saving medication. But some people who have inflammatory types of arthritis and rely on the drug to keep their disease under control are also concerned about access to methotrexate.

“For the most part, this should be a manageable situation for arthritis patients,” says Donald Miller, PharmD, a professor of pharmacy practice at North Dakota State University, in Fargo. That’s because the majority of people with arthritis who take methotrexate – which is used in the treatment of rheumatoid arthritis, psoriatic arthritis, lupus and certain types of juvenile arthritis – use the pill form. There is no shortage of that right now.  

The root of the problem lies with the preservative-free, injectable form of methotrexate. Very high doses of it are used to treat pediatric cancer patients, and that is the form of the medication that is running dangerously low.

And now that shortage is increasing demand on other, injectable forms of methotrexate. “When you get shortages with even one product, it does have a ripple effect on everything else,” Miller says.

In this case, the form of injectable methotrexate with preservatives is being affected. It is used by arthritis patients (at much lower doses than cancer patients) when methotrexate pills don’t provide enough relief or cause unpleasant side effects. Some people may still be able to fill their prescriptions for injectable methotrexate at certain locations. For those who can’t, there are other options that may work for them until the shortage is resolved – which could be within two weeks, federal health officials said Thursday.

The shortage developed after one of the major suppliers of the preservative-free injectable medication, Ben Venue Laboratories, shut down an Ohio plant in November because of manufacturing problems identified during inspections by the Food and Drug Administration, or FDA, and other global regulatory agencies. Manufacturers of the type with preservatives are now reporting shortages due to increased demand.

In response to growing concerns that the medication shortage will worsen, the FDA said that Ben Venue will now release its emergency supplies of the injectable, which were produced before the shutdown, and two other manufacturers will step up production.