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Methotrexate is one of the most effective and commonly used medications in the treatment of rheumatoid arthritis and other forms of inflammatory arthritis, and also may be used to treat lupus, inflammatory myositis, vasculitis, and some forms of childhood arthritis. It is often used in combination with other medications to treat arthritis. It is known as a disease-modifying anti-rheumatic drug (DMARD), because it not only decreases the pain and swelling of arthritis, but it also can decrease damage to joints and long-term disability.
Methotrexate comes either as pills or as a subcutaneous injection. Methotrexate is usually taken as a single dose once per week, although occasionally the dose is split into two doses, taken once per week, to improve absorption or avoid side effects. Your doctor also may prescribe a folic acid (or folate) vitamin supplement to decrease the chance of side effects. Methotrexate should not be taken if kidney or liver function is not normal. Alcohol significantly increases the risk for liver damage while taking methotrexate, so alcohol should be avoided. Regular laboratory monitoring is required to monitor blood counts and your liver while taking methotrexate. Improvements in arthritis and other conditions usually are first seen in three - six weeks. The full benefit of this drug may not be seen until after 12 weeks of treatment.
Methotrexate can lower the ability of your immune system to fight infections. If you develop symptoms of an infection while using this medication, you should stop it and contact your doctor. The most common side effects are gastrointestinal upset and elevations of liver function tests.
About 1 - 3% of patients develop mouth sores (called stomatitis), rash, diarrhea, and abnormalities in blood counts. Some side effects do not cause symptoms, so it is important to have routine blood tests performed every 8 - 12 weeks.
Methotrexate may cause cirrhosis (scarring) of the liver, but this side effect is rare and most likely to occur in patients who already have liver problems or are using alcohol or taking other drugs that are toxic to the liver. Lung problems (persistent cough or unexplained shortness of breath) can occur rarely when taking methotrexate. Slow hair loss is seen in some patients, but hair grows back when the person stops taking this medication. This can often be managed by taking folic acid. It is important to remember that most patients do not experience side effects, and that, for those who do, many of the minor side effects will improve with time.
You should contact your rheumatology provider if you develop symptoms of an infection, such as a fever or cough, or if you think you are having any side effects. Be sure to let your rheumatology provider know if you are pregnant, planning to get pregnant, or if you are breastfeeding. Methotrexate treatment should be discontinued for at least three months before attempting to become pregnant. Even though methotrexate should not be taken during pregnancy, it does not reduce a woman’s chance of becoming pregnant in the future. Men taking methotrexate should talk to their physician prior to attempts to conceive. If you are planning on having surgery or will be receiving chemotherapy or radiation therapy, talk to your rheumatology provider first.
Updated December 2020 by Osman Bhatty, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.
This patient fact sheet is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.