In my clinical experience, not everyone is the best candidate for methotrexate. Businessmen who feel alcohol consumption is part of their ability to finish business deals are uncomfortable taking methotrexate and I am uncomfortable prescribing for them. Men and women who are hoping to bear children ...

I strongly endorse the use of methotrexate (MTX) as initial therapy in patients with a new RA diagnosis who have a significant erosive disease. Clearly, this subset of patients is likely to require a combination of therapies including concomitant MTX and a biological drug. Considerable evidence has ...

I have more than several patients that have stable or healed erosions only taking MTX for years validated by repeat x-ray/MRI. Those with quite an inflammatory disease are started on MTX 15 mg weekly and in 6 weeks if still an active disease, I take them up to 25 mg weekly. If not significantly bett...

For practical purposes, would use MTx and at the same time apply for biologic prior authorization, this way I don’t lose time, however always start with MTX. It might suffice on its own, especially in sero-pos disease because is more sensitive to therapy.