Methotrexate is one of the most widely used and effective medicines for autoimmune and inflammatory arthritis. It belongs to a group of medicines called Disease-Modifying Anti-Rheumatic Drugs (DMARDs).
Helps control inflammation in conditions such as rheumatoid arthritis, psoriatic arthritis, lupus, vasculitis, and ankylosing spondylitis (peripheral joints).
Works by reducing overactivity of the immune system, helping to protect joints, organs, and tissues from long-term damage.
Methotrexate does not provide instant relief — most people notice improvement in 6–12 weeks, with full benefit often by 6 months.
Effective in reducing symptoms and slowing joint damage in over 60% of patients.
Enhances long-term outcomes, especially when used alongside other treatments like biologics or additional DMARDs.
Surprisingly, studies indicate it may even prolong life in people with rheumatoid arthritis.
Reduces joint pain, swelling, and stiffness.
Slows or prevents joint damage, protecting long-term mobility.
Improves quality of life and function.
Can be used alone or with other medicines, including biologics.
Taken once a week only (not daily).
Usual dose: up to 20 mg weekly by tablet, or 25–30 mg by injection.
Always taken with folic acid on separate days to reduce side effects.
Can be taken with food to reduce stomach upset.
Most people tolerate methotrexate well. Side effects are usually mild and can improve with dose adjustment or folic acid.
Common: nausea, fatigue, mild hair thinning, mouth ulcers, diarrhoea.
Less common: abnormal blood tests, liver irritation, or lowered blood counts.
Rare but serious: lung inflammation (particularly in smokers), liver scarring (with long-term use and high alcohol intake).
Call your doctor immediately if you develop:
Shortness of breath, persistent cough, fever, yellowing of the skin/eyes, or unexplained bruising.
Alcohol can increase the risk of liver problems.
Safe limit: up to 14 units per week, no more than 3 units per day, with at least 2–3 alcohol-free days per week.
Regular blood tests are essential to monitor your blood counts, liver, and kidney function.
Monthly at the start.
Every 2–3 months once stable.
Women: Methotrexate must be stopped at least 3–6 months before conception. It is unsafe in pregnancy and breastfeeding.
Men: Current evidence suggests methotrexate does not harm sperm, but some specialists still advise a 3-month washout before trying for a pregnancy. Discuss with your rheumatologist.
Recommended: flu vaccine (yearly), pneumococcal, shingles (Shingrix), COVID-19, meningococcal, Haemophilus influenzae type b.
Live vaccines (MMR, yellow fever, oral typhoid) should be avoided.