Methotrexate for Arthritis: How It Works, Safety and Blood Tests
Short answer: Methotrexate is a widely used disease-modifying medicine for rheumatoid arthritis, psoriatic arthritis and some other inflammatory conditions. It is taken once a week, never daily. It needs regular blood tests to check your blood counts, liver and kidneys. Take it exactly as your rheumatologist prescribes.
What does methotrexate do?
Methotrexate calms an overactive immune system. In arthritis it is used in low doses, given once a week, to reduce joint inflammation and prevent joint damage. It can take 6 to 12 weeks to work fully, so do not stop it early just because you feel no change at first. See rheumatoid arthritis treatment.
The most important safety rule: once a week
Taking methotrexate daily by mistake is dangerous and can be life-threatening. Choose a fixed day of the week, write it on the packet, and tell your family. If you are ever unsure whether you have taken your dose, do not take another one; call your doctor or pharmacist.
Folic acid
Your rheumatologist will usually prescribe folic acid on a different day, which reduces side effects such as nausea and mouth ulcers.
Blood tests while on methotrexate
Methotrexate can affect your blood counts, liver and kidneys, so monitoring is essential. A typical pattern is frequent tests at the start, such as every two to four weeks, and then every three months once the dose is stable, but your rheumatologist sets the schedule.
| Test | What it checks |
|---|---|
| CBC (complete blood count) | White cells, red cells and platelets |
| LFT (liver function) | Liver enzymes |
| KFT (kidney function) | Creatinine and urea; the kidneys clear methotrexate |
| CRP / ESR | Whether the arthritis is settling |
Immunix Labs offers these monitoring tests at both OARC centres and at home.
Common side effects
- Nausea, loss of appetite, tiredness
- Mouth ulcers
- Mild hair thinning
- Raised liver enzymes (found on blood tests)
Most are mild and settle with folic acid or a dose change made by your doctor.
Call your doctor promptly if you have
- Fever, a sore throat or other signs of infection
- New cough or breathlessness
- Mouth ulcers that get worse, unusual bruising or bleeding
- Yellowing of the skin or eyes, or dark urine
- A rash or severe vomiting or diarrhoea
Things to avoid or discuss first
- Alcohol: keep it to a minimum, and ask your doctor what is safe for you.
- Pregnancy and breastfeeding: methotrexate must be stopped well before trying for a baby. Talk to your rheumatologist first.
- Other medicines: some antibiotics (such as trimethoprim or co-trimoxazole) and other medicines interact with methotrexate. Tell every doctor and pharmacist you take it.
- Vaccines: avoid live vaccines. Ask about flu and pneumonia vaccines.
Do not mix with unlabelled “joint pain” medicines
Some herbal or unlabelled joint-pain remedies sold in India contain hidden steroids or painkillers. Always tell your doctor everything you take. See Ayurveda vs. modern rheumatology treatment.
Frequently asked questions
How long will I take methotrexate?
Often for years. Many people stay on it long term because stopping can bring the disease back. Your doctor reviews the dose and whether it is still needed.
Can I take painkillers with methotrexate?
Often yes, at the dose your doctor advises, but some painkillers (NSAIDs) need care with methotrexate, especially if the kidneys are affected. Ask before combining.
Does methotrexate cause cancer or serious infections?
Serious problems are uncommon and are why regular blood tests and check-ups are required. The disease itself, if untreated, also carries risks. Your rheumatologist weighs these with you.
What if I miss a dose?
Take it as advised by your doctor or pharmacist, but never double up the next week. Ask what to do in advance.
Book an appointment
You can book online at OARC Saheed Nagar or OARC Sailashree Vihar in Bhubaneswar, or call or WhatsApp +91 93386 53086. OARC Saheed Nagar is open Monday to Saturday, 9:00 AM–2:00 PM and 4:30–9:00 PM. OARC Sailashree Vihar is open Monday to Saturday, 8:00–9:00 AM and 5:00–6:00 PM. Both are closed on Sunday. Tests ordered at your visit can be done at our in-house laboratory, Immunix Labs, with sample collection at both centres and at home.
Sources
- NHS: Methotrexate
- Ledingham J, et al. BSR and BHPR guidelines for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs. Rheumatology 2017;56:865–868.
- NICE guideline NG100: Rheumatoid arthritis in adults
Medical review: Dr. Jyoti Ranjan Parida, DM (Rheumatology), review pending. This article is general information and not a diagnosis. See our editorial policy.
