Which of the following is a counselling point for a patient starting methotrexate for rheumatoid arthritis?

• A. Wear suncream and avoid UV light
• B. Take folic acid daily
• C. Avoid grapefruit juice
• D. Monitor blood glucose daily

Answer: (A)

Starting methotrexate for rheumatoid arthritis requires counseling about potential photosensitivity. Methotrexate can make the skin more susceptible to sunburn and sun-induced rashes, so protecting the skin is an important preventive measure from the very beginning. Advise wearing broad-spectrum sunscreen ( SPF 30 or higher), applying it regularly, and using protective clothing, hats, and sunglasses, while also limiting sun exposure during peak hours. This helps reduce skin-related adverse effects and avoids misinterpretation of a simple sun reaction as something more concerning.

Folic acid is also routinely used with methotrexate to lessen toxicity, and while important, the question highlights sun protection as a particularly key counseling point at initiation. The other options—for example avoiding grapefruit juice or daily blood glucose monitoring—are not standard, primary counseling messages for starting methotrexate in rheumatoid arthritis.