Peter. C. Taylor 1,*, Alejandro Balsa Criado 2, Anne-Barbara Mongey 3, Jerome Avouac 4, Hubert Marotte 5 and Rudiger B. Mueller 6


Methotrexate (MTX) is a remarkable drug with a key role in the management of rheumatoid arthritis (RA) at every stage of its evolution. Its attributes include good overall efficacy for signs and symptoms, inhibition of structural damage and preservation of function with acceptable and manageable safety, a large dose-titratable range, options for either an oral or parenteral route of administration, and currently unrivalled cost-effectiveness. It has a place as a monotherapy and also as an anchor drug that can be safely used in combination with other conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or used concomitantly with biological DMARDs or targeted synthetic DMARDs. MTX is not without potential issues regarding toxicity, notably hepatotoxicity and bone marrow toxicity, as well as tolerability problems for some, but not all, patients. But many of these issues can be mitigated or managed. In the face of a welcome expansion in available targeted therapies for the treatment of RA, MTX looks set to remain at the foundation of pharmacotherapy for the majority of people living with RA and other inflammatory rheumatic diseases. In this article, we provide an evidence-based discussion as to how to achieve the best outcomes with this versatile drug in the context of a treat-to-target strategy for the management of RA.


Author information :
1 : Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
2 : Rheumatology unit, University Hospital La Paz, Institute for Health Research–IdiPAZ, Universidad Autonoma de Madrid, 28046 Madrid, Spain.
3 : St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
4 : Paris Descartes University, Sorbonne Paris Cité, Rheumatology Department, Cochin Hopital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
5 : SAINBIOSE, INSERM U1059, Université de Lyon, Saint-Etienne, France Service de Rhumatologie, CHU Saint-Etienne, 42055 Saint-Etienne, France
6 :Division of Rheumatology, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland

* Author to whom correspondence should be addressed
Received: 13 March 2019 / Accepted: 11 April 2019 / Published: 15 April 2019

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