Rheumatoid arthritis (RA) is a chronic autoimmune disorder. If you have this condition, you are familiar with the swelling and painful joints it causes.

These aches and pains are not caused by the natural wear and tear that occurs with aging. Instead, your immune system mistakenly attacks the lining of your joints in addition to other organs and tissues in your body. No one knows for sure why this happens or why some people develop this condition.

There is no cure for RA, but there are ways to treat it. For example, a doctor might prescribe medications that slow down the progression of the disease or suppress your immune system. They may also give you drugs that just reduce joint swelling and pain.

The current recommendation for the initial treatment of RA is with disease-modifying anti-rheumatic drugs (DMARDs). One of these drugs is methotrexate. Keep reading to learn how this medication works, including how effective it is in treating RA.

Methotrexate is a DMARD, a class of medications often used in the early stages of RA. A few drugs in the DMARD class were specifically made to treat RA.

Methotrexate was developed for a different reason. It was initially created to treat cancer, but it can work to treat RA, too. It is available only in generic form and 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. But keeping the immune system in check this way slightly increases your risk of infections.

While methotrexate comes with the chance of side effects, it also offers great benefits for people with RA. Methotrexate can prevent joint damage if you use it early enough after your RA symptoms first appear. For more advanced cases, it can also slow down further joint damage and relieve symptoms of RA.

RA may also increase your risk for other conditions such as heart disease and diabetes. Methotrexate may decrease the risk of developing these conditions in people with RA.

But due to its high potency and effectiveness in treating RA, the benefits of this medication may be 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 they can no longer tolerate its effects on their immune system.

Methotrexate is the go-to drug for treating RA because it works well.

According to the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR), methotrexate is the drug of choice when starting RA therapy. The amount of research done since the early 1980s supports methotrexate as the mainstay of therapy.

Studies show good safety, flexible dosing, low cost, and treatment success.

Doctors writing the new treatment guidelines for ACR and EULAR note that methotrexate must be used to its full potential. This means doctors should target the best dosing quickly and switch to an injectable form if pills are not working well enough.

Methotrexate often beings to work within 3 months, and then therapy is continued for at least 6 months to evaluate the full benefits of the medication. Once there is relief from symptoms and joint damage after taking methotrexate for a time, some doctors may try to reduce your dose to the lowest possible level.

In combination with other drugs

Even if you do not reach remission with methotrexate alone, combinations with other DMARDs or medications for pain and inflammation can make methotrexate more effective. Keep this in mind if you do not respond to methotrexate by itself. You can talk with the prescribing doctor about combination therapy.

In addition to having a high level of effectiveness, methotrexate is also prescribed for its safety profile, and serious side effects are uncommon. But like all medications, methotrexate can cause side effects, including:

  • upset stomach
  • fatigue
  • thinning hair or hair loss
  • mouth ulcers
  • pancytopenia, or low red blood cell, white blood cell and platelet levels
  • high liver enzyme levels
  • drowsiness
  • decrease in appetite
  • diarrhea

Having low kidney function or using other medications combined with methotrexate can increase the risk of side effects.

Folic acid is prescribed along with methotrexate to help prevent these problems. During treatment with methotrexate, a doctor will check your blood cell counts, liver function tests, kidney function, and lung function. Changes to your blood cell counts or liver function tests may cause a doctor to lower your dosage.

Methotrexate may cause a slight increase in your risk of developing an infection.

Even if you have side effects, you may not need to stop the drug. Instead, the doctor may decrease your dosage to see if they will go away. But allergic inflammation in the lungs, a severe yet rare side effect, will require stopping methotrexate.

If you have RA, talk with a doctor about methotrexate. With a long track history and decades of research, methotrexate has been shown to work well without causing severe or difficult-to-manage side effects.