Methotrexate in Rheumatoid Arthritis

Over the past few years 'low dose pulse' methotrexate has gained increasing popularity as an effective treatment for refractory rheumatoid arthritis. Methotrexate has been shown to be better than placebo in controlled clinical trials. These studies showed methotrexate to be relatively safe and efficacious with treatment up to six months duration. Methotrexate seems to maintain its anti-rheumatic activity for at least two years, and is well tolerated over long periods of time. However, patients controlled on methotrexate for up to 40 months of continuous therapy have been shown to flare within four weeks of ceasing methotrexate, suggesting that the disease is suppressed rather than eliminated