Examples

Methotrexate is given weekly either as a shot (injection) or by mouth (orally).

How It Works

Methotrexate interferes with the production and maintenance of DNA, the genetic material in the cells of your body. It is not known exactly how methotrexate works in rheumatoid arthritis, but it can reduce inflammation and slow the progression of the disease. Methotrexate is considered a disease-modifying antirheumatic drug (DMARD). DMARDs are also called immunosuppressive drugs or slow-acting antirheumatic drugs (SAARDs).

Why It Is Used

Methotrexate reduces inflammation caused by rheumatoid arthritis. It is the most common DMARD used to treat rheumatoid arthritis.¹ Methotrexate may be used:

• In the early stages of rheumatoid arthritis to prevent disease progression.
• In combination with other medicines such as other DMARDs.

How Well It Works

Methotrexate is effective in relieving joint inflammation and pain, slowing disease progression, and preventing disability by delaying joint destruction.² People with rheumatoid arthritis may be more likely to continue treatment with methotrexate than with other DMARDs because of favorable results and tolerable side effects. Studies indicate that more than 50% of people who take methotrexate for rheumatoid arthritis continue taking the medicine for more than 3 years, which is longer than any other DMARD.³

Methotrexate is often the first DMARD prescribed for rheumatoid arthritis and usually provides relatively fast relief of at least some symptoms. If you can tolerate methotrexate, but it is not effective, your rheumatologist will recommend that you take another DMARD along with methotrexate (combination therapy). Several recent studies report that treatment results are improved when methotrexate is given with another DMARD. For example, one study found that methotrexate used in combination with etanercept, a new DMARD, is more effective at reducing disease activity than methotrexate alone.⁴ Studies with infliximab and adalimumab have shown similar results.¹

Combination therapy may allow for lower doses of an individual drug to be used, which may reduce the risk of adverse effects that can occur with higher doses. In one large review of studies, various combinations of DMARDs plus methotrexate were more effective than either methotrexate or another DMARD alone.⁵

Side Effects

Common side effects, which are reversible once the medicine is stopped, include:

• Nausea.
• Hair loss.
• Skin rash.
• Mild liver inflammation (elevation of liver enzyme blood test).
• Fatigue and feeling like you have the flu.
• Mouth sores.
• Diarrhea.
• Low blood counts.