Treatment of early rheumatoid arthritis: Methotrexate and beyond |
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| Affiliation: | 1. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;2. Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA;3. Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, USA;1. Department of Medicine, University of Colorado Denver - Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, CO 80045, USA;2. Department of Medicine, Division of Rheumatology, University of Colorado Denver - Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, CO 80045, USA;1. Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, China;2. National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China;3. Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410078, China;4. Hunan Provincial Key Laboratory of Cardiovascular Research, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410078, China;5. Geriatric Medical Center, People''s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, 7500002, P.R. China;1. Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain;2. AETSA, Evaluación de Tecnologías Sanitarias de Andalucía, Fundación Pública Andaluza Progreso y Salud, Spain;3. Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain |
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| Abstract: | For the last several decades, the standard of care for the initial management of rheumatoid arthritis (RA) has been methotrexate. Methotrexate is effective as monotherapy and in combination with conventional, biologic, and targeted-synthetic therapies. Methotrexate is generally well-tolerated, but has important, albeit uncommon, potential side-effects including a risk of liver toxicity and cytopenias. Some studies suggest that more active monitoring in patients with fatty liver disease may be appropriate. With reassuring safety data, more rapid dose escalation and use of subcutaneous therapy may provide even greater success. Some off-target benefits such as a reduction in cardiovascular disease risk have also been demonstrated, though these studies may suffer from confounding. Recent published guidelines continue to endorse methotrexate as first-line therapy. Methotrexate is a low-cost, safe, and effective therapy for RA that should not be overlooked nor too quickly abandoned. |
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| Keywords: | Rheumatoid arthritis Methotrexate Treatment |
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