Rheumatoid arthritis (RA) is a chronic autoimmune condition that causes joint pain, swelling, and stiffness. One of the most trusted and widely recommended treatments for RA is methotrexate. Here, we’ll explain how methotrexate works, its dosage, side effects, and when it might be time to switch to a biologic medication.
Why Methotrexate Is the First-Line Treatment for RA
Methotrexate has been the go-to medication for rheumatoid arthritis since the 1980s. Although initially developed as a chemotherapy drug in the 1940s, researchers discovered its effectiveness in controlling RA later. This medication works by reducing the immune system’s overactivity, which is the primary cause of RA.
Doctors recommend methotrexate because it is:
✅ Effective in controlling inflammation
✅ Affordable
✅ Backed by decades of research
Unlike simple pain relievers, methotrexate is a DMARD (Disease-Modifying Anti-Rheumatic Drug). This means it not only reduces joint inflammation but also slows down disease progression, preventing long-term joint damage.
How Methotrexate Works
In RA, the immune system mistakenly attacks the body’s joints, leading to inflammation and damage. Methotrexate helps by suppressing this overactive immune response. By doing so, it protects joint function and improves long-term outcomes.
Methotrexate Dosage and Forms
Methotrexate is typically taken once a week. The standard starting dose is between 7.5 to 10 milligrams per week, which may be increased based on how well your body responds. Dosage can go up to 20-30 milligrams per week if needed.
It comes in two forms:
- Oral Tablets (often the first choice)
- Injections (useful for reducing gastrointestinal side effects and improving absorption)
Side Effects and Safety Tips
Like all medications, methotrexate has potential side effects, including:
- Nausea
- Fatigue
- Mild Hair Thinning
Methotrexate can also affect your liver and immune system, so regular blood tests are essential, typically every three months. Taking folic acid supplements helps minimize side effects like mouth sores, nausea, and hair loss.
Important Safety Note: Methotrexate is not suitable for pregnant or breastfeeding women, or those with severe liver or kidney disease.
When to Switch to Biologic Medications
If methotrexate isn’t controlling your symptoms after 3 to 6 months or the side effects are too difficult to manage, it may be time to consider biologic medications. Biologics target specific parts of the immune system and can be life-changing for many RA patients.
Even if you switch to a biologic, methotrexate is often continued, as combining the two treatments is typically more effective than using biologics alone.
Partner with Your Doctor
Treatment decisions are always a partnership between you and your doctor. Whether you stay on methotrexate or transition to a biologic, the goal is to control inflammation, keep you active, and help you live your best life.
🩺 Need more information? Watch the full video and visit chicagoarthritis.com to learn more about managing rheumatoid arthritis.
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