Methotrexate is the most commonly used medication for severe Rheumatoid Arthritis. It not only decreases the pain and swelling, but also helps to protect the joints from deformities and damage. Most people who take methotrexate (MTX) have no side effects, and most have a noticeable benefit. If pills don’t work, I often switch to injectable MTX. Although most patients have no side effects from MTX, there are some potential risks, and there are special instructions for taking it.

MTX can be toxic to the liver, lungs, or bone marrow (where blood cells are made). In order to monitor for problems, all patients who take MTX go to the lab every month for CBC, and liver function tests. I usually give a 10-week supply of MTX with no refills. When you run low, call for a refill. This procedure prevents someone from getting multiple refills without going to the lab, and potentially harming their liver. When you call for a refill, be sure you have been to the lab in the past 30 days.

MTX can cause sores in the mouth. This minor problem is prevented by taking Folic Acid (a B vitamin) 1mg a day. I give a prescription of this to everyone on MTX.

Anyone who takes MTX should avoid alcohol. Using alcohol while on MTX does increase the risk of liver damage.

MTX can cause birth defects. Women of child bearing age need to use contraception if they take MTX. Pregnancy is OK 6 months after MTX is stopped.

Most importantly, MTX is taken only once a week. Most medications are taken daily, but not MTX. Even if a label says to take MTX daily, don’t! MTX is only to be taken once a week. This is true for both the injectable and the oral form.

MTX can be safely taken for decades. Many rheumatoid arthritis patients continue to do very will on low dose weekly MTX. Most patients suffer no side effects, and avoid joint damage by taking MTX.

There are new agents used to treat rheumatoid arthritis. Some are similar to MTX, like Arava. Others are used when MTX or Arava alone are not effective enough. They are not to be used in people who have not been on MTX first.

The beneficial effects of MTX take an average of 8 to 12 weeks to occur. Similarly, if someone stops taking MTX, the beneficial effects take 8 to 12 weeks to wear off.