By Dr Pauline Habib, Rheumatologist
Methotrexate is one of the most commonly used medications in rheumatology, helping many people manage conditions like rheumatoid arthritis and psoriatic arthritis. Yet, despite its long track record, it remains surrounded by myths and concerns.
In my recent talk on BJC Connect, I broke down some of the biggest misconceptions about methotrexate, explaining what Rheumatology patients really need to know about its safety, side effects, and how to use it with confidence.
Methotrexate is what we call a disease-modifying anti-rheumatic drug (DMARD)—it helps control inflammation and prevent joint damage. A key point: it’s not an immunosuppressant. Instead, it fine-tunes the immune system to stop it from attacking the joints. 🦵
Most people tolerate methotrexate well, and side effects—if they do occur—can often be managed with simple adjustments. Regular monitoring allows us to catch and address any issues early.
One of the most frequent questions I get is about methotrexate and lung disease. While there is a small risk, it’s very rare, and regular check-ups help us keep an eye on things.
Another hot topic: alcohol. You don’t need to completely avoid it, but moderation is important for liver health. Enjoying the occasional drink is generally fine—just be mindful and chat with your doctor if you’re unsure. 🥂
Another common belief is that methotrexate is an immunosuppressant, but that’s actually a misconception. Methotrexate is an immunomodulatory drug, meaning it helps adjust and regulate the immune system rather than completely suppressing it. This distinction is important because, while some medications weaken the immune system, methotrexate works to bring immune activity back into balance, helping to reduce inflammation without shutting it down entirely.
This is a concern for many, but the reality is that the underlying autoimmune disease itself is what slightly increases cancer risk, not methotrexate. If someone does develop cancer, we often stop methotrexate—not because it causes cancer, but to focus on the cancer treatment.
👉 Regular cancer screenings—like mammograms and PSA checks—are important for everyone, not just those on methotrexate. In Australia, with our high rates of skin cancer, it’s especially crucial to practice sun safety and have skin checks as needed.
If you get an infection while on methotrexate, should you stop taking it? The answer depends.
Why does this matter? Because stopping methotrexate unnecessarily can lead to a flare, which may require steroids—another medication that can affect immune function.
🥳 Good news: most vaccines are perfectly safe to get while on methotrexate, including flu, pneumonia, hepatitis B, and COVID-19 boosters. These help protect you against preventable illnesses.
Live vaccines (like MMR or yellow fever) need a bit more planning. If you need one, it’s best to get it before starting methotrexate, or discuss the timing with your doctor.
👉 Many people believe that methotrexate starts working within a few days or weeks, but it actually takes longer to reach its full effect. While some may notice small improvements earlier, it typically takes around three months for the medication to work at its best. This gradual process happens because methotrexate helps adjust immune system activity over time rather than providing immediate relief. Sticking with the treatment plan and keeping in touch with your healthcare provider can help you get the most benefit from the medication.
Managing a chronic condition isn’t just about one medication. Regular check-ins with your GP for heart health, cancer screenings, and general well-being are just as important. Methotrexate can be a powerful tool, but looking after your overall health 💪 is key to staying well.