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Keywords : Methotrexate, oral ulceration, mucositis, DMARD, pancytopenia, rheumatoid arthritis Abbreviations MTX: methotrexate MIOM: methotrexate-induced oral mucositis DMARDs: disease-modifying anti-rheumatic drugs RA: rheumatoid arthritis LDMTX: low-dose methotrexate ADR: adverse drug reaction UPOHC: University of Pretoria Oral Health Centre FBC: full blood count RCC: red cell count Hb: haemoglobin MCV: mean corpuscular volume MCH: mean corpuscular haemoglobin MCHC: mean corpuscular haemoglobin concentration GERD: gastroesophageal reflux disease eGFR: estimated glomerular filtration rate DHFR: dihydrofolate reductase DHF: dihydrofolate THF: tetrahydrofolate TS: thymidylate synthase AICART: aminoimidazole carboxamide ribonucleotide transformylase RFC1: reduced folate carrier 1 MTX-PG: methotrexate-polyglutamate PPI: proton pump inhibitor INTRODUCTION Methotrexate (MTX) was originally developed to treat malignant diseases

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While the gluten-free diet has been found to improve Hashimotos symptoms and reduce the autoimmune attack on the thyroid, its important to note that selenium deficiency can be caused or worsened by gluten and grain-free diets, as demonstrated in nutritional studies involving people with celiac disease