Are DMARDS really toxic- focus on Methotrexate.

Today, let us focus on Methotrexate; the king of DMARDs. Yes, you heard it right.. The King. It has been crowned the king by Rheumies, Scientists & patients alike.
· Rheumatologists- it is the most frequently prescribed DMARD for Rheumatoid Arthritis (RA) across the globe.
· Scientists – Most studies of biologics include patients who are not responding to Methotrexate, underlying its role as the most important DMARD.
· Patients- Studies have shown that patients continue Methotrexate longer than any other DMARD; thus making it the most tolerated DMARD.
So, if you have RA & are on Methotrexate, be rest assured that you are with the King. You are taking the world’s most trusted DMARD.

For the newly diagnosed, someone may scare you that Methotrexate is a cancer medication. Yes it is; but in a very high dose as compared to that for RA. Just the way salt is used in many dishes, even drugs like Methotrexate are used in many different conditions. And, mind you, RA is akin to cancer. The swollen rogue synovium proliferates like a cancer tissue & eats up the cartilage & bones. Methotrexate works against these rogue cells, be it cancer or RA.
This is just the glimpse of the King.
Probably, I’ve hyped a bit. Shortly, we’ll have a look at the effects on RA & the side effects to decide whether it is really toxic.


  1. My wife taking Methotexate for last 7-8 months. She seems to have tolerated well. No side effects noticed. nor there any nausia or acidity. She does not require any form of antacid.



  2. I am taking methotrexate for lupus. I do not have RA, however I had severe joint inflammation, with swelling in pain. It is harsh on my stomach, so I am also taking folic acid and I experience nausea frequently.

    What is a DMARD? And will you be further discussing whether mtx is toxic? I kind of didn’t get that in this post.



  3. I took Methotrexate years ago to control my lupus (SLE). This was a low dose, and I had little side effects (slight hair loss, mostly).

    Recently, though, I was administered a high dose for a missed miscarriage. I was hospitalized twice after the reactions I had. The first was severe chest and abdomin pains. The second was for sever leg edema. In my opinion, this medication is toxic, and great precautions should be taken before it is administered. I know I will not be taking this medication again.



    1. It is a matter of dose.

      Compare the dose –small doses used in RA/ SLE (15- 25 mg/ week) & dose for ectopic pregnancy 50-70 mg on days 0, 2, 4, and 6; or a single dose of 80-90 mg IM). Higher doses are bound to be associated with side effects.

      We’ll have a look at the whether small dose methotrexate is toxic in the subsequent blogposts.



  4. Methotrexate is very effective in Rheumatoid Arthritis. Side effect can be avoided by folic acid. My sincere thanks to Dr.Akerkar who has prescribed me Methotrexate 15 mg weekly and folic acid and after consuming around 3 years, presently I have no symptom of Rheumatoid Arthritis and very soon I am going to stop all my medicine. Rheumatoid Arthritis is curable only we require positive attitude towards it and a good Rheumatologist.



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