Although only recently approved for use in treating rheumatoid arthritis (RA), methotrexate sodium has assumed an important role in the polypharmacologic treatment of this disease, thus warranting review of recent experience with this cytotoxic folate analogue. Methotrexate has proved beneficial for RA in all studies,1-5 although its use has been limited to patients with inflammatory synovitis refractory to established remittive agents (such as gold or penicillamine) or with significant reactions to these drugs. Side effects of low-dose weekly methotrexate in carefully selected patients with RA, although frequent,1-5 have usually been mild and responsive to dosage reduction or to changes in administration.
In 12- to 18-week, double-blind, placebo-controlled trials of methotrexate for RA, moderate to marked suppression of synovial inflammation, which is often evident within the relatively short time of 5 to 6 weeks, is seen in one third to two thirds of patients,1,5 Maximum clinical and functional