If you’re living with rheumatoid arthritis (RA) and experience urinary tract infections (UTIs), you may wonder whether they’re an RA symptom, a treatment side effect, or an unrelated diagnosis. RA is an autoimmune disorder known primarily for causing inflammation of the joints, but it can negatively affect the entire immune system.

Additionally, methotrexate — one of the most common disease-modifying antirheumatic drugs (DMARDs) to treat RA — has a number of side effects, sometimes including UTI symptoms. One myRAteam member said, “I am on 15 [milligrams] of methotrexate and seem to have a never-ending UTI.”

Read on to learn about the risk factors for UTIs related and unrelated to methotrexate, as well as what you can do to prevent and treat UTIs if you’re living with RA.

Risk Factors for a Urinary Tract Infection

Risk factors for UTIs include age, sex, and sexual activity. Mayo Clinic notes that women have shorter urethras — the tube through which urine travels from the bladder — compared to men. This shorter distance means women have a greater likelihood of external bacteria reaching their bladder, resulting in a UTI. Sexual activity, especially unprotected sex with a new partner, increases your risk for a UTI due to exposure to foreign bacteria.

Furthermore, some birth control methods — primarily spermicides and diaphragms — can increase your UTI risk. According to AARP, postmenopausal woman have a higher risk for UTIs than younger women due to changing pelvic anatomy and reduced estrogen levels. Once you’ve had one UTI, you are at elevated risk for recurrent infections (facing additional UTIs in the future).

Since rheumatoid arthritis is more likely to occur in women than in men and is most often diagnosed in people of reproductive age, you may find yourself facing multiple UTI risk factors at once.

Rheumatoid Arthritis and UTIs

RA is an inflammatory disease that leads to an overactive immune system. Rheumatic diseases cause the body to attack its own cells, leading to a dysfunctional immune response and symptoms of infection.

One study published in Clinical Rheumatology found that people with RA face more than two times the risk of UTIs as those without RA. In this study, researchers found that UTI hospitalizations and serious infections occurred mostly in individuals who were older (average age of 76 years) and 90 percent of those who developed UTIs were female. The co-occurrence of RA and UTIs was even higher in those with long-term use of corticosteroids, such as prednisone.

The association between RA and UTIs may actually go both ways. A study published in Scientific Reports found that antibiotics used to treat UTIs and other bacterial infections may actually trigger RA flares. So, if you’re frequently taking antibiotics for recurrent UTIs, the medication may be worsening your RA symptoms.

Methotrexate and UTIs

If you are taking methotrexate for RA, you may have experienced one or more gastrointestinal, cognitive, or immunological side effects. Some less-common side effects of methotrexate include burning while urinating, blood in the urine, and dark urine, which may or may not be associated with a UTI.

The DMARD methotrexate is known to weaken the immune system. While it helps reduce the autoimmune effects of RA, methotrexate can also reduce the body’s defense against external bacteria, such as the bacteria that causes UTIs. A 2019 study in Journal of Clinical Medicine looked at past research from 1980 through 2017 about methotrexate therapy for people with inflammatory diseases, including RA. Researchers found that methotrexate use was associated with a higher risk of all infections in people with RA — but not in other inflammatory rheumatic conditions, such as psoriatic arthritis Crohn’s disease.

These research findings don’t necessarily mean that methotrexate causes UTIs. If you do experience UTI symptoms while on methotrexate, it could be a side effect of treatment or due to other risk factors.

Many other medications for rheumatoid arthritis also weaken the immune system and have a similar increased risk for UTIs.

Urinary Tract Infection Symptoms

People with multiple risk factors for UTIs, like taking methotrexate and living with an autoimmune condition, should be aware of the symptoms of a UTI. The earlier you identify a UTI, the easier it will be to treat it. Common UTI symptoms include:

• Frequent urination
• Burning or stinging sensation while urinating
• Cloudy, red, pink, or dark urine that has a strong odor
• Pelvic pain

If you have any of these symptoms, book an appointment with your health care provider. They may have you provide a urine sample so that they can run tests and determine whether you do have a UTI. These tests, along with your symptoms and risk factors, will help your doctor decide how to treat the infection.

Urinary Tract Infection Treatment

It may be hard to know the cause of a UTI — whether it’s due to having RA, DMARD treatment, or other risk factors. Regardless, treatment for a UTI will be similar no matter what caused it.

Symptomatic UTIs are typically treated with antibiotics, which should be taken exactly as directed by a doctor. This means continuing to take the full course of treatment even if symptoms have disappeared after a few days. Early discontinuation of antibiotics could lead to antibiotic resistance, making UTIs harder to treat in the future.

Make sure your doctor knows about your RA diagnosis and that you’re on methotrexate when they write your antibiotic prescription. Similarly, make sure that your rheumatologist knows about your antibiotic use before introducing methotrexate into your treatment regimen.

Your rheumatologist may temporarily suspend your methotrexate or other DMARD while you’re taking antibiotics for an infection. This is to help your immune system to combat the infection. Make sure to let your rheumatologist know if you have any infection so that they can determine if you should continue your DMARD while being treated for an infection.

Don’t Ignore UTI Symptoms

If you are on methotrexate for RA, it is important that you understand your increased risk for UTIs. Waiting to treat a UTI increases the risk of infections in the kidney and bladder — and even necrosis (cell death, which can lead to illness, injury, or organ failure). This can increase the likelihood that you’ll experience recurring UTIs. If you’re experiencing UTI symptoms, whether or not you believe they are side effects of methotrexate, make sure to speak to your doctor to get necessary treatment early.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 192,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA. Here, finding ways to manage and time rheumatoid arthritis treatment while improving quality of life is a commonly discussed topic.

Have you experienced a UTI while on methotrexate? How have you dealt with the side effects of methotrexate? Share your experience and advice in the comments below, or start a conversation by posting on your Activities page.