What to know about methotrexate for rheumatoid arthritis

ahsan65@gmail.comSeptember 2, 2025

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What to know about methotrexate for rheumatoid arthritis

Methotrexate is one of the oldest and most profitable drugs available for rheumatoid arthritis (RA). It is also one of the most commonly used RA therapies.

Here’s what you need to know about this medication if you have Ra.

1. Methotrexate is a first -line treatment of RA

Methotrexate is part of the category of anti-rhumatic drugs modifying the disease, or Dmard. These drugs do more than manage symptoms; They actually slow down the progress of the disease.

About 60% of PR people are currently underway or are on methotrexate according to the Johns Hopkins Arthritis Center.

In addition to being an effective treatment, methotrexate works relatively quickly and has a softer side profile than the other drugs used for PR, explains Andrew Tenpas, Pharmd, assistant teacher of pharmacy in Texas A&M University in Kingsville, Texas.

“We have so much experience with methotrexate, and we know it’s effective and safe,” said Bahar Moghaddam, MD, rheumatologist at Mount Sinai Hospital in New York.

2. Methotrexate fights inflammation

PR is an inflammatory form of arthritis. Methotrexate is believed to work by freeing up a molecule called adenosine which blocks chemicals that promote inflammation.

Reducing inflammation helps prevent pain and joint lesions otherwise felt by people with the disease.

Scientists realized very early that the drug, initially used to treat cancer, could be useful for PR. In the 1980s, golden studies in gold began to confirm its value for this condition.

Initially, as with many drugs for PR, methotrexate was mainly given late during the disease, when damage to the joints were already caused. In 2010, the American College of Rheumatology, as well as its European counterparts, reorganized their diagnostic criteria for the disease so that people can be diagnosed earlier. Their objective was to “refocus attention to the important need for an earlier diagnosis and an institution of effective therapy for the suppression of diseases”, wrote scientists.

3. Your doctor will determine your dose

Most people with PR start with a dose of 7.5 milligrams (MG) of methotrexate tablets taken once a week. Over time, if that is not enough to help you, your doctor will increase your dosage, maybe up to 20 mg. The pills are 2.5 mg each and the usual dose is 3 to 10 pills.

According to the Arthritis Foundation, most people take a weekly dose between 10 and 25 mg for inflammatory arthritis.

“It is extremely important to understand that the drug is taken once a week, not once a day,” said Dr. Tenpas, noting that the confusion of this dose has led to toxicity in some patients.

Methotrexate can also be given by weekly injection. People can give themselves a blow of methotrexate using a self-injector. Taking the drug in this way allows more to enter your system without increasing unwanted side effects.

Doses for injected medication are generally similar to those of the oral version. The injection is available in 25 mg / ml or 50 mg / 2 ml of bottles. The usual dose is 7.5 mg at 25 mg per week.

4. Methotrexate does not provide immediate relief

Because methotrexate does not simply remove the symptoms of pain, it can take people for a while to see if the drug is effective.

You can see an improvement in the symptoms three to six weeks after the start of the medication, but the complete advantages can take even more time, up to 12 weeks, according to the American College of Rheumatology.

For many people, methotrexate alone – once it starts to work – is enough to manage the symptoms of PR, but if you continue to have symptoms after 12 weeks, talk to your doctor other treatment options, such as the combination of methotrexate with other drugs modifying the disease.

5. Methotrexate has some side effects

As with many drugs, people may experience unpleasant side effects and in rare dangerous cases of methotrexate. If you are experiencing something that concerns you, be sure to speak with your health care provider.

Side effects may include:

Gastrointestinal It is the most common side effect for people with PR.

Mouth wounds Up to a third party, people taking methotrexate for PR develop oral ulcers.

Headache and fatigue Sometimes called “methotrexate fog”, it could happen one day after taking a dose of methotrexate.

Loss Hair loss or thinning on methotrexate is slow and reversed once you stop taking the medication; Folic acid taking can also help to counter this effect.

Rash

Dizziness

Methotrexate can also reduce the ability of the immune system to combat infections.

People who take methotrexate should call their doctor immediately if they experience more serious side effects. These include crises, confusion, the weakness of one or both sides of the body, blurred vision or sudden loss of view and loss of consciousness.

6. You may be able to minimize these side effects

Certain side effects of methotrexate result from a drop in folic acid levels in the body. To reduce these effects, doctors generally prescribe folic acid supplements with the drug.

Many people find that taking oral medicine with food can prevent stomach aches, says Tenpas.

Some experts recommend dividing the dose, taking half of the morning and the other half-12 hours later to relieve these gastrointestinal side effects. If that does not help, tell your doctor to spend oral to the injectable version of the drug.

To cope with oral wounds, the foundation of arthritis suggests using a rinse of salt water or a special fog rinse containing a lidocaine analgesic.

If nausea is a problem, you can request a prescription for anti-natural drugs.

7. Methotrexate is not for everyone

Methotrexate is contraindicated for those who suffer from certain conditions and diseases, in particular:

Liver or cirrhosis disease

Alcohol consumption disorder

Kidney disease

Blood disorders

HIV / AIDS

People undergoing radiotherapy

Pregnancy concerns

Do not take methotrexate if you are pregnant, try to become pregnant or if you are breastfeeding. He can interfere with fetal development and can go into breast milk. The arthritis foundation recommends using at least two contraception methods while you are under methotrexate and for at least three months after your intervention.

For men, many experts recommend waiting at least three months after stopping the drug before trying to design.

Methotrexate can have an impact on the effectiveness of the vaccine

Because methotrexate affects the immune system, researchers have found that it can blunt the effectiveness of certain vaccines.

The American College of Rheumatology recommends subject to the delay in the dosage of methotrexate for two weeks after flu and COVVI-19 vaccines, if the activity of the disease allows.

Anyone who takes methotrexate should work with his doctor to discuss his specific drug diet at the time of any vaccine.

Interactions with other drugs

It is essential to let your doctor know which other medicines you take, including vitamins or supplements. Do not take methotrexate while taking antibiotics containing trimethoprime-sulfa (Bactrim, Sulfatrim).

8. Methotrexate can increase the risk of liver disease

The release of Adenosine, which was fighting against inflammation, also causes the accumulation of scar tissue in the liver.

Because methotrexate has been associated with liver damage, people with PR often worry about how to take the drug will affect this crucial organ.

Fortunately, people who take this medication for the PR seem to have a lower risk that people who take it for other conditions.

However, due to the potential of liver problems, regular consumption of alcohol with methotrexate is not considered safe. “People are encouraged to minimize – if not to avoid – alcohol consumption,” explains Tenpas.

9. Regular blood tests are necessary to monitor

When you are under methotrexate, routine blood tests will be carried out every 4 to 12 weeks to check your liver function and your complete blood count (CBC), as methotrexate can also lead to a decrease in blood count.

All the negative effects of the drug do not cause notable symptoms, which is why routine blood tests are useful for people who take this medication. Your rheumatologist can make changes to your methotrexate dose in the event of a problem.

The point to take away

Methotrexate is a pillar treatment of rheumatoid arthritis, recognized for its ability to slow the progression of the disease and to provide relief of symptoms when used regularly.

Although methotrexate can take a few weeks to show advantages, many people with PR find that it helps to effectively manage symptoms over time, often in combination with other therapies if necessary.

Side effects such as gastrointestinal problems, oral wounds and fatigue are common, but these can often be managed by adjustments such as folic acid, doses division or transition to an injectable form.

It is crucial to discuss potential drug interactions and vaccine planning with your doctor, because methotrexate affects the immune system and can interact with other drugs, including certain antibiotics.