Methotrexate medication use for rheumatoid arthritis and other medical condition
October 15 2018 by
Ray Sahelian, M.D.


Methotrexate is the most commonly prescribed drug for slowing the progression of rheumatoid arthritis. Methotrexate belongs to the group of medicines known as antimetabolites. It is used to treat cancer of the breast, head and neck, lung, blood, bone, and lymph, and tumors in the uterus. It may also be used to treat other kinds of cancer, as determined by your doctor. Methotrexate blocks an enzyme needed by the cell to live. This interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal body cells may also be affected by methotrexate, other effects will also occur. Some of these may be serious and must be reported to your doctor. Other effects, like hair loss, may not be serious but may cause concern. Some effects may not occur for months or years after the medicine is used.


Ann Rheum Dis. 2013 Dec. Biologic and oral disease-modifying antirheumatic drug monotherapy in rheumatoid arthritis. Clinical evidence demonstrates coadministration of tumour necrosis factor inhibitor (TNFi) agents and methotrexate (MTX) is more efficacious than administration of TNFi agents alone in patients with rheumatoid arthritis, leading to the perception that coadministration of MTX with all biologic agents or oral disease-modifying antirheumatic drugs is necessary for maximum efficacy. Real-life registry data reveal approximately one-third of patients taking biologic agents use them as monotherapy. Additionally, an analysis of healthcare claims data showed that when MTX was prescribed in conjunction with a biologic agent, as many as 58% of patients did not collect the MTX prescription. Given this discrepancy between perception and real life, we conducted a review of the peer-reviewed literature and rheumatology medical congress abstracts to determine whether data support biologic monotherapy as a treatment option for patients with rheumatoid arthritis. Our analysis suggests only for tocilizumab is there evidence that the efficacy of biologic monotherapy is comparable with combination therapy with MTX.

Methotrexate side effects, safety
Methotrexate commonly causes diarrhea, nausea and vomiting. The most frequently reported methotrexate side effects include ulcerative stomatitis, leukopenia, nausea, and abdominal distress. Other frequently reported methotrexate side effects are malaise, undue fatigue, chills and fever, dizziness and decreased resistance to infection.


Vestn Rentgenol Radiol. 2015. Pulmonary cytotoxicity induced by bleomycin and methotrexate.

Dosing of Methotrexate
The dose will be different for different patients. The methotrexate dose that is used may depend on a number of things, including what the medicine is being used for, the patient's size, whether the medicine is being given by mouth or by injection, and whether or not other medicines are also being taken.


Alcohol use, wine
Q. I am a 60 yo female, diagnosed with RA in Oct 2014 following 12 months of symptoms. I am well controlled by a traditional Rx cocktail of Meloxicam 7.5 mg per day, Plaquenil at 200 mg twice a day, and Methotrexate 2.5 mg X 6 oral tablets once a week. I have read several studies, including one of yours, reporting the health benefits of low to moderate consumption of Red Wine. In addition, I have read studies regarding Methotrexate and the consumption of alcohol. In general, it appears that the medical community in the USA would advise against any alcohol consumption while taking Methotrexate. But the medical community in the UK appears to support the idea that low to moderate consumption of Red Wine, in light of it's stated health benefits, is not a concern. Would you share with me what your professional opinion is regarding the consumption of Red Wine, in low to moderate amounts, while taking low dose Methotrexate.
   A. I have not studied this topic in detail but it would seem to me that an ounce or two of wine a few times a week should not interfere with this mediction.

Methotrexate may exert some of its anti-inflammatory effects by boosting tissue levels of a protein called adenosine. Given that caffeine can block the cell receptors that adenosine acts on, it is possible that it could also blunt methotrexate's effects. Studies in rats have indeed found that high doses of caffeine weakened methotrexate's actions, while some human studies have suggested it could have a similar effect in people.does not appear to impair the effectiveness of methotrexate for treating rheumatoid arthritis (RA), Boston researchers report.


Role of folic acid
Cochrane Database Syst Rev. July 2013. Folic acid supplementation for rheumatoid arthritis patients on methotrexate: the good gets better.