Methotrexate – friend or foe?

What is Rheumatology

Methotrexate – friend or foe?

There has been much in the recent news about Methotrexate and its potential dangers. Some of my patients have been in to tell me how disappointed they are with the sensationalist news coverage as it is a medication that in their opinion is easy to take, controls their disease really well, without side effects. My patients have told me it is not possible to confuse the methotrexate with folic acid and that it’s very clear that you take it only once a week!

Nonetheless, Methotrexate is a strong drug and many people are understandably apprehensive about it when considering necessary treatment for their arthritis, or autoimmune conditions. It is a drug that has potential side effects and yes, if taken daily, either accidentally or deliberately, it will result in extreme illness, if not death.

It is natural to be concerned about potential side effects when reading about medications, in particular methotrexate.

But it’s important to remember that the side effects are only potential side effects and they are not a definite, in the same way that driving a car does not result in all of the injuries – including death – that can possibly result from driving a car.

I can share with you that most of my patients do very well on methotrexate. It is a very cheap drug, and when understood how to take correctly, i.e. once a week only, it is usually very safe and very well tolerated by people, and, importantly it is usually very effective at controlling arthritis symptoms 🙂 Of course it doesn’t agree with everyone, and if this happens we stop it and try something else.

We are all different and in medicine we need to try things first before we see whether they work or cause side effects in each person.

In my practice, I see that arthritis and autoimmune diseases can be absolutely crippling. They can result in devastating consequences long term as well as the short term effects of the illness which cause immense pain, stiffness, and disability, both physical as well as emotional with all of its impact on the rest of a person’s life.

These effects are a definite without treatment, whereas the side effects of methotrexate are just a possibility.

On the other hand, methotrexate offers a far stronger possibility of controlling disease, with 50% of people with rheumatoid arthritis being symptom free on methotrexate alone. In contrast only a few people get side effects on methotrexate.

There are potential side effects of methotrexate and it is important to be aware of them. You can read all about them here.

If I was healthy I definitely would not want to take it, and it is not a perfect medication by any stretch of the imagination and I would never say it was! But given the trade off of the problems with rheumatoid arthritis versus the possibility of side effects with methotrexate, seeing how effective it was, and overall how well tolerated it is, I would consider it my friend before considering it my foe. That said:

The choice is always yours to decide whether methotrexate is your friend or your foe.

Speak to your doctor about methotrexate if you have any concerns and make sure taking methotrexate is a good choice for you.


You may be interested in reading my safety tips on how to take methotrexate here.


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