Rheumatoid arthritis (RA) is a chronic autoimmune disorder. If you have this condition, you’re familiar with the swelling and painful joints it causes. These aches and pains aren’t caused by the natural wear and tear that occur with aging. Instead, your immune system mistakes the lining of your joints for foreign invaders and then attacks your body. No one knows for sure why this happens or why some people have this disease.

There’s currently no cure for RA, but there are ways to treat it. Your doctor might prescribe medications that slow down the progression of the disease or suppress your immune system. They may also give you drugs that reduce inflammation and pain in your joints.

The current recommendation for initial treatment of RA is with disease-modifying antirheumatic drugs (DMARDs). One of these drugs is methotrexate. Check out how this medication works, including how effective it is in treating RA.

Methotrexate is a type of DMARD. DMARDs are a class of medications often used in the early stages of RA. A few drugs in the DMARD class were specifically made for treating RA, but methotrexate was developed for a different reason. It was originally created to treat cancer, but it’s been found to work for RA too. It’s sold under the brand names Rheumatrex and Trexall. It comes as an oral tablet and a solution for injection.

Methotrexate and other DMARDs work to reduce inflammation. They do this by suppressing your immune system. There are risks linked with keeping your immune system in check this way, though, including an increased risk of infections.

While methotrexate comes with the chance of side effects, it also offers great benefits for people with RA. DMARDs can prevent joint damage if you use them early enough after your RA symptoms first appear. They can also slow down further joint damage and alleviate symptoms of RA. Most doctors and people with RA think the benefits of this medication are worth the risks.

Methotrexate is a long-term drug when used for RA. Most people take it until it no longer works for them or until they can no longer tolerate its effects on their immune system.

Methotrexate is the go-to drug for most doctors treating RA. This is due to how well it works. According to Johns Hopkins, most people take methotrexate for a long time compared to other DMARDs—up to five years. This reflects how effective it is in treating the condition and how well most people tolerate it.

The numbers show that methotrexate helps most people with RA. According to the National Rheumatoid Arthritis Society, more than half of people taking it see a 50 percent improvement in the course of their disease. And more than one-third of people see a 70 percent improvement. Not everyone will find relief with methotrexate, but it works better for more people than other DMARDs.

If methotrexate treatment didn’t work for your RA the first time, there’s still hope. A study

In combination with other drugs

Methotrexate is often used with other DMARDs or other medications for pain and inflammation. It has shown to be a great partner. Certain combinations of two or more DMARDs—always with methotrexate as one component—work better than methotrexate alone. Keep this in mind if you don’t respond to methotrexate by itself. You can talk to your doctor about a combination therapy.

Besides the fact that it works for many people, doctors like to use methotrexate because serious side effects are uncommon. But like all medications, methotrexate can cause side effects. Common side effects can include:

  • upset stomach
  • fatigue
  • thinning hair

You may be able to lower your risk of these side effects if you take a folic acid supplement. Ask your doctor if this supplement is right for you.

Learn more: Can folic acid reduce the side effects of methotrexate? »

In rare cases, methotrexate can cause serious side effects. These can include:

  • cirrhosis
  • low white blood cell levels (can lead to infections)
  • low red blood cell levels (can cause fatigue)
  • low platelet levels (can lead to bleeding)
  • lung disease

During treatment with methotrexate, your doctor may check your blood cell counts, liver function, and lung function. If you have serious side effects, your doctor may stop your treatment.

If you have RA, talk to your doctor about methotrexate. This drug has been shown to work well without causing many side effects for people with RA. If methotrexate doesn’t work to treat your RA symptoms, your doctor may give you a higher dosage or another drug to take along with methotrexate.