How Methotrexate Works to Treat Rheumatoid Arthritis

Methotrexate belongs to a class of drugs called antimetabolites. This type of medication slows the growth of skin cells or cancer cells and suppresses the immune system.

In addition to treating rheumatoid arthritis, methotrexate is prescribed to people with severe psoriasis, as well as some types of cancer.

Methotrexate is also known as a disease-modifying anti-rheumatic drug (DMARD) and works by reducing pain and swelling. By slowing the progression of the disease, methotrexate may also help prevent joint damage.

It may take 12 weeks or more to get the full benefit from methotrexate treatment, but you may feel better after as little as 3 to 6 weeks.

Methotrexate is the main drug treatment for rheumatoid arthritis because it is both effective and tolerable. So how can you tell if it’s working for you?

In the weeks and months after starting treatment, you may notice:

• decreased pain
• less painful joints
• less morning stiffness
• less swelling in the joints

How well methotrexate works for you can be affected by your age, gender, race, genetics, and other health conditions.

Your results may also depend on how long you’ve had rheumatoid arthritis and how severe it is.

Methotrexate is available in tablet form and is taken by mouth on a schedule prescribed by your doctor, depending on your condition. You may be given a low dose at first with instructions to increase the dose over time.

It is important to follow your doctor’s instructions regarding when and how much methotrexate to take.

These side effects can occur:

• dizziness
• headache
• sleepiness
• painful, swollen gums
• Red eyes
• no feeling of hunger
• hair loss
• mouth ulcers
• loose stools
• fatigue
• nausea

Taking folic acid can reduce common side effects.

You should avoid alcohol because the risk of liver damage increases while taking the drug. You should also avoid smoking as there is little chance of getting pneumonia.

Methotrexate can cause birth defects, so people trying to conceive should stop taking methotrexate for at least 3 months before trying to conceive. Methotrexate must also be discontinued during pregnancy and lactation.

If you were born female and received methotrexate, you should speak to your doctor before trying to conceive.

Although low doses of methotrexate are usually well tolerated, serious side effects are possible. These include:

• vision changes
• seizures
• confusion
• weakness
• faint

Regular blood tests are needed while taking methotrexate, as the drug can cause liver or kidney problems. The blood tests can detect minor abnormalities, and your doctor can change the dosage before a serious problem arises.

Pills vs. Shots

Methotrexate is also available as an injection, although side effects are usually the same for both the tablet and shot forms.

With the shot form of the drug, you inject it under the skin on your abdomen or thighs. Hypodermic needles or pre-filled pens are the delivery methods.

Injectable methotrexate is sometimes prescribed when the pill format doesn’t seem to work. This form of the drug is also used in people experiencing stomach side effects with the pill form.

When injected, methotrexate can increase blood levels of the drug, which can lead to improved responses.

Your symptoms should improve within 3 to 6 weeks of starting methotrexate treatment. It may take 12 weeks or more to see the full benefits.

When you take methotrexate by mouth, it circulates in your blood for the next 24 hours. However, the real benefit occurs when methotrexate builds up in your inflamed joints over time.

Drug absorption into your cells is a slow process, which explains why it can take weeks or months for it to take full effect.

But methotrexate can decrease your immune system’s ability to fight infection. Contact your doctor if you develop an infection, as serious infections that require hospitalization can be a cause for concern.

Rheumatoid arthritis is an autoimmune or inflammatory disease. This means your immune system attacks healthy cells that cause inflammation. The signs of inflammation are usually swelling and pain.

People who take methotrexate usually see an improvement in swelling, pain, and signs of inflammation after 12 weeks of taking the drug. By reducing inflammation in the joints, methotrexate helps prevent permanent joint damage.

For those taking methotrexate for 3 months or more and not showing signs of improvement, other medications may be needed.

While you wait for relief from your methotrexate treatment, you can talk to your doctor about other ways to relieve your rheumatoid arthritis symptoms.

Regular exercise can help. That Centers for Disease Control and Prevention (CDC) recommends 150 minutes of moderate activity per week, such as bicycling, walking, or swimming, for people with rheumatoid arthritis.

The Arthritis Foundation recommends these self-care tips:

• Build movement into your day, even if it’s just a little walking or gentle stretching.
• Rest during a flare-up to reduce inflammation.
• Use hot or cold compresses to relieve pain or reduce swelling.
• Try meditation, massage, acupuncture, or acupressure to reduce stress and pain.
• Consider taking turmeric or fish oil supplements, which can reduce inflammation.
• Reach out to friends, family, and the community for emotional support.

Before making any dietary changes or starting any supplements, it’s important to talk to your doctor.

Methotrexate is often the first-line treatment to control rheumatoid arthritis symptoms, reduce inflammation, and prevent permanent joint damage.

Your symptoms should improve within 3 to 6 weeks of starting methotrexate treatment, but it may take 12 weeks or more to see the full benefits.

While you wait for methotrexate to take full effect, talk to your doctor about how your symptoms are changing and what you can do to get relief.