Part 2: Good Effects of Methotrexate for Rheumatoid Arthritis

Why would I use methotrexate for Rheumatoid Arthritis?

For thousands of patients with rheumatic diseases, methotrexate has been the miracle drug they hoped for. Historically, before methotrexate, Rheumatoid Arthritis patients could mostly only treat their symptoms. There was no effective way to attack the disease itself. The only hope of real improvement was spontaneous remission, which is rare. (There were a couple other drugs of its generation, but this has been the most effective and the most safe long term.)

Okay, so how does methotrexate help Rheumatoid Arthritis? Why is it the most commonly prescribed medication for RA? What can it do for me?

How can methotrexate be disease modifying?

Methotrexate interferes with an enzyme important to DNA replication; this has the effect of inhibiting cell reproduction. That’s why it’s called an “immunosuppressive” drug. It is not known exactly how, but this suppresses immune activity.

Methotrexate is also referred to as a “disease modifying anti-rheumatic drug” or DMARD. It is called that because it can modify the course of an incurable disease. DMARDs can inhibit disease progression. This may mean remission for some patients and at least a great improvement of symptoms for most others.

Why is methotrexate popular with RA doctors?

As early as the 1940’s, methotrexate was formulated for use in various cancers, like lymphoma. After that, it was used experimentally for rheumatic-type diseases. It was not officially approved by the FDA for Rheumatoid Arthritis until the 1980’s. Although it is still unknown exactly why it helps, there are decades of history to examine. And there are many patients who have used it for a long period, which makes doctors more comfortable with it.

Methotrexate works well in combination with other DMARDs, including a newer class of them called Biologics. A higher percentage of patients successfully achieve reduced symptoms by adding methotrexate to another therapy. So, other drugs work better with methotrexate than those same drugs work alone. Combination therapies like this are highly recommended by the American College of Rheumatology for moderate to severe Rheumatoid Arthritis to slow disease progression and reduce pain and inflammation quickly, often within a few weeks.

Sound so fantastic that you want to give some as a Christmas gift? Not so fast. There are some drawbacks. Next we’ll look at some of those issues and how they can be addressed.