Insights into methotrexate in rheumatoid arthritis: a clinical review

Abstract

Objective: To review the efficacy and safety profile of methotrexate in rheumatoid arthritis.

Data source: Published original research work and reviews were searched in English related to efficacy and safety profile of methotrexate in rheumatoid arthritis.

Study design: Only articles that emphasis on efficacy and safety profile of methotrexate in rheumatoid arthritis.

Data extraction: Online and library searches done.

Data synthesis: Data added and summarized.

Conclusion: Methotrexate (MTX) has been the mainstay of treatment of patients with Rheumatoid Arthritis (RA). It has been used for over 50 years as the backbone in the treatment in a number of rheumatic diseases and thus it remains a gold standard of therapy for RA. Clinical trial results indicate that weekly low dose MTX is generally safe and effective in the treatment of RA. Factors that favour a good response to MTX are male gender, non-smoking, early disease stage, absence of previous DMARD use, lower baseline disease activity, concomitant corticosteroids, inflammatory biomarkers (TNF-α levels, ESR, CRP) and HLADRB1 shared epitope (SE)-negativity. Folate supplementation has been shown to reduce the risk of adverse events.