Is Methotrexate Effective for Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a chronic autoimmune disorder. If you have RA, you experience swelling and painful joints. These aches and pains aren’t caused by the natural wear and tear that occurs with aging. Instead, your immune system mistakes the lining of your joints for foreign invaders and attacks. No one knows for sure why this happens or why some people have this disease.
RA Treatments, but No Cure
Unfortunately, you can’t be cured of RA, but you can treat it. Your doctor might prescribe medications that reduce inflammation and pain in your joints. You might also be given drugs that slow down the progression of the disease or medications that suppress your immune system.
The current recommendation for initial treatment of RA is with disease-modifying antirheumatic drugs.
Disease-modifying antirheumatic drugs (DMARDs) are a class of medications usually used in the early stages of RA. They reduce inflammation by suppressing the immune system.
Although there are risks associated with keeping your immune system in check, DMARDs can prevent damage from accumulating in the joints if used early enough. Most doctors and patients consider the benefits of this medication worth the risks.
An Accidental DMARD
A few drugs in the DMARD class were specifically created for treating RA. Others were developed for different reasons, but have been found to work for RA too. Methotrexate is one such drug. It was developed as a cancer drug, and is sold under the brand names Rheumatrex and Trexall.
Methotrexate is currently the go-to drug for most doctors treating RA patients. It is also used to treat other autoimmune diseases like multiple sclerosis, Crohn’s disease, and lupus.
The Successes of Methotrexate
Methotrexate has become a standby for RA treatment because of its effectiveness. According to Johns Hopkins, most patients take methotrexate for a long period of time compared to other DMARDs—up to five years. This reflects both its effectiveness as a treatment and the fact that it’s tolerated well by most people.
Methotrexate is known to reduce symptoms of RA and slow down the joint damage created by the disease.
Exactly How Effective Is Methotrexate?
The numbers show that methotrexate does help most people with RA. According to the National Rheumatoid Arthritis Society, more than half of patients taking it see a 50 percent improvement in the course of their disease. More than one third of patients see a 70 percent improvement.
Although not everyone will find relief with methotrexate, it works for more people than other DMARDs.
If you have RA and methotrexate treatment didn’t work for you, there’s still hope. A study found that when methotrexate fails the first time, it’s worth trying again.
Several patients who had little or no success with the drug originally were given another go with methotrexate at higher doses. The second time around was largely effective for these people.
Methotrexate and Heart Disease
Not only can methotrexate be effective at treating RA, it can also help people live longer. Studies have shown that methotrexate is one of the safest DMARDs. Also, patients taking it live longer than those who take other types of immune-suppressing drugs. The exact reasons are unclear, but it seems that patients taking methotrexate are less likely to die from heart disease.
Methotrexate in Combination
Methotrexate is often used with other DMARDs, and has proven to be a great partner. It combines well with other drugs in its class. Certain combinations of two or more DMARDs—always with methotrexate as one component—are more effective than methotrexate alone. Keep this in mind if you don’t respond to methotrexate by itself.
Methotrexate Side Effects
Besides the fact that it works for most people, doctors like to use methotrexate because serious side effects are rare. These can include cirrhosis of the liver, myelosuppression, and interstitial pneumonitis. Less severe side effects are possible, including digestive upset, fatigue, and thinning hair. Risk for side effects can be reduced if you take a folic acid supplement with methotrexate.
Drug Guide: DMARDs. (2013). Arthritis Foundation. Retrieved August 5, 2013, from http://www.arthritistoday.org/arthritis-treatment/medications/types-of-drugs/disease-modifying-drugs/drug-guide-dmards.php
● Kaltsonoudis, E., Charalampos, P., and Drosos, A. (2012). Current and Future Role of Methotrexate in the Therapeutic Armamentarium for Rheumatoid Arthritis. Int. J. Clin. Rheumatol., 2012; 7(2): 179-189. Retrieved August 5, 2013, from http://www.medscape.com/viewarticle/761828
● Kapral, T., Stamm, T., Machold, K., Montag, K., Smolen, J., and Aletaha, D. (2006). Methotrexate in Rheumatoid Arthritis is Frequently Effective, Even if Re-Employed after a Previous Failure. Arthritis Res. Ther., 2006; 8(2): R46. Retrieved August 5, 2013, from http://www.medscape.com/viewarticle/524546
● Methotrexate in Rheumatoid Arthritis. (2011, November 15). National Rheumatoid Arthritis Society. Retrieved August 5, 2013, from http://www.nras.org.uk/about_rheumatoid_arthritis/newly_diagnosed/which_drugs_are_used/methotrexate_in_rheumatoid_arthritis.aspx
● Rau, R., and Herborn, G. (2004). Benefit and Risk of Methotrexate Treatment in Rheumatoid Arthritis. Clin. Exp. Rheumatol., 2004; 22 (Suppl. 35): S83-S94. Retrieved August 5, 2013, from http://www.clinexprheumatol.org/article.asp?a=2442
● Rheumatoid Arthritis Treatment. (2012, October 10). The Johns Hopkins Arthritis Center. Retrieved August 5, 2013, from http://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/#metho