Methotrexate (also called MTX for short) is a medication prescribed for rheumatoid arthritis (RA). Methotrexate is a disease-modifying antirheumatic drug (DMARD), which means it slows the progression of RA. It’s the most commonly prescribed DMARD for RA, perhaps because it’s recommended by leading medical associations (such as the American College of Rheumatology and the European League Against Rheumatism) as a first treatment. Methotrexate can be used at any stage of the disease, on its own in the early stages or in combination with other medications. Methotrexate is also used to treat psoriasis, psoriatic arthritis, juvenile arthritis, lupus, and some forms of cancer (at much higher doses than for RA).
No one knows exactly how methotrexate works, but it interferes with processes in the body that cause inflammation and joint damage. So it relieves the joint pain, swelling, redness, and fatigue that come with RA.
Methotrexate comes in two forms for RA—an oral pill and a subcutaneous shot. Most people start out taking the pill form, but they may switch to subcutaneous methotrexate if the pills don’t work as well as they once did. Taking methotrexate subcutaneously helps get more of the drug into a person’s system. You may want to ask your doctor about the different dosing options and which one is right for you.
Methotrexate has a long history of safety and is considered one of the safest treatments for RA. That doesn’t mean it doesn’t have any side effects, however. Gastrointestinal symptoms (stomach upset and vomiting) can occur with oral methotrexate.
Why is methotrexate a cornerstone treatment for rheumatoid arthritis?
Methotrexate was actually developed in the 1940s as a cancer treatment, but years later it showed promise as an RA treatment. Today, it’s the foundational therapy in RA, and it’s often the first drug patients are prescribed after they are diagnosed. As many as 90% of all RA patients will take methotrexate at some point. Interestingly enough, it is still used to treat many forms of cancer, but at much higher doses than what is prescribed for RA.
There are many reasons why methotrexate makes sense for RA:
It reduces the symptoms of RA (pain, swelling, redness)
It’s a DMARD-a disease-modifying antirheumatic drug-which means it slows the progression of the disease and associated joint damage
It is a flexible therapy and can be used alone or combined with other types of medications, including biologic therapies
The combination of effectiveness and safety profile makes methotrexate a therapy many patients can stay on for years.
What are some of the most common questions about methotrexate?
Is methotrexate a cure?
Unfortunately, there is no cure for rheumatoid arthritis (RA). Methotrexate helps relieve many of the symptoms of RA, but it won’t cure the disease.
How long will I take methotrexate?
You can take methotrexate as long as it’s effective and helps improve your symptoms. Your doctor may prescribe other medications along with methotrexate as your disease progresses.
Is methotrexate the medicine I see in TV commercials?
Probably not. Chances are the medications you have seen advertised on TV are called biologic therapies, which are commonly prescribed by rheumatologists and are often used concurrently with methotrexate.
Does methotrexate work as well as those newer medicines?
Although many biologic therapies are now available, methotrexate is still considered the cornerstone of RA treatment and is usually the first medicine prescribed. In fact, biologic therapies have been found to work better and longer when combined with methotrexate.
Does methotrexate therapy require any lab tests?
Some RA drugs, including methotrexate, can cause organ damage. That’s why you’ll have to undergo routine lab tests so your doctor can monitor your liver and kidney functions. These tests are performed as often as your doctor thinks best, usually every several weeks.
Can I drink alcohol while taking methotrexate?
Methotrexate has been associated with liver damage, so many doctors recommend abstaining from alcohol while you are on therapy. Make sure you ask your doctor before mixing methotrexate and alcohol.
Can I take methotrexate if I’m pregnant?
No. Methotrexate can cause negative effects, including fetal death of an unborn child. Women of childbearing age should not take methotrexate until pregnancy has been excluded. Pregnancy should be avoided if either partner is taking methotrexate. Methotrexate also should not be taken by nursing mothers.
Why did my dose change?
Probably because your current dose wasn’t controlling your symptoms as well as it once was. Your doctor most likely increased your dose to better control your symptoms.
How long does it take to work?
Most patients see symptom relief in about 3 to 6 weeks, although it can take up to 12 weeks for methotrexate to reach its full effect. That’s why it’s important to give the therapy enough time to work for you.
Will it make me sick?
It’s true that some patients experience nausea and vomiting while taking methotrexate pills. Studies have shown that subcutaneous methotrexate (an injection under the skin) may be easier on the stomach than pills.
Do I have to take it on the same day every week?
Yes, you should take your methotrexate on the same day each week.
Can I take ibuprofen with my methotrexate?
Yes, you can take ibuprofen with methotrexate.
Why do some people take folic acid with methotrexate?
Methotrexate, originally created as a cancer drug, stops cells from multiplying by blocking a form of vitamin B called folic acid. Depleting your body of folic acid can have consequences, including side effects such as nausea, vomiting, hair loss, and mouth ulcers. The good news is that taking a folic acid supplement (a synthetic form of folate) can help reduce these side effects. One study found that folic acid reduced stomach upset and mouth sores by 79%.
Does methotrexate cause weight gain?
There’s no evidence that methotrexate causes weight gain.
The myth: There’s no difference between oral and subcutaneous methotrexate.
The reality: There are a few differences between these two forms of methotrexate, actually. The subcutaneous form delivers more methotrexate into the blood. That is why studies have shown it is more effective than the oral form when it comes to controlling rheumatoid arthritis (RA) symptoms. And for many people, subcutaneous methotrexate is easier on the stomach than the pill form.
The myth: Methotrexate takes too long to work.
The reality: Most patients begin to feel symptom relief between 3 and 6 weeks, and studies have shown that patients had significant symptom improvement within 3 months of treatment. Patients may continue to improve for up to 1 year, with relief sustained even longer.
The myth: Methotrexate is chemotherapy and poisons the body.
The reality: It’s true that methotrexate has been used effectively to treat many different cancers. However, the doses used in cancer treatment are much higher than those used in RA. For example, the dose used in RA is typically no more than 25 mg/week, whereas doses for cancer can range from 15 mg/day up to 175 mg/week.
The myth: Methotrexate doesn’t work as well as biologic therapy.
The reality: Actually, multiple studies have shown that in approximately 30% of patients with RA, methotrexate taken alone was effective for controlling symptoms.
The myth: Methotrexate doesn’t slow or stop the progression of RA.
The reality: Several studies that followed patients for at least 3 years have shown that methotrexate slowed or stopped disease progression as well as biologic therapy did in 60% to 70% of patients.