Methotrexate is used in all of the follow ing except:

Ans. a. Sickle cell anemia (Ref: Katzung l1/e p631-632; KDT 7/e p210, 863, 882, 6/e p203, 841]Methotrexate is not used in sickle cell anemia."Methotrexate is now considered the first line DMA RD agent for most patients with Rheumatoid arthritis. The anti- inflammatory effect of methotrexate in rheumatoid arthritis appears to be related at least in part to interruption of adenosine and possible effect on TNF pathways."Which DMARD should be the drag of first choice remains controversial and trials have failed to demonstrate a consistent advantage ofone over the other? Despite this, methotrexate has emerged as the DMARD of choice especially in individuals with risk factors for the development of bone erosions or persistent synovitis of >3 months duration because of its relatively rapidity of actiont its capacity to effect sustained improvement with ongoing therapy and the higher level of patient retention on therapy""Methotrexate is a folate antagonist, it causes reduction in cells reproductive abilities. Methotrexate affects cells, which divides quickly. In psoriasis cells divide more than usual. Methotrexate binds to these cells and inhibits enzymes involved in rapid growth of skin cells. It is commonly used to stop the progression ofpsoriatic arthritis and less commonly used in the treatment of severe psoriasis with no arthritis component Methotrexate is an effective antipsoriasis agent. It is especially useful in acute generalized pustular psoriasis, psoriatic erythroderma, psoriatic arthritis and extensive chronic plaque psoriasis.Methotrexate although widely used has not been shown benefit in ankylosing spondylitis. There is not enough evidence to be certain of the benefit and harms of methotrexatefor ankylosing spondylitis amhnore research is needed. In ankylosing spondylitis the use of methotrexate is not recommended for the axial manifestations. The drug may have some efficacy- in the peripheral involvement. For this disease there is lack of clinical trials and most of the trials did not show efficacy on the axial symptoms of the disease.