Methotrexate for rheumatoid arthritis

Treatment of patients with rheumatoid arthritis (RA) conventionally starts with an analgesic plus a non-steroidal anti-inflammatory drug (NSAID). Slow-acting antirheumatic drugs are being added at an increasingly early stage of the disease.1 When we reviewed slow-acting antirheumatics two years ago1 methotrexate had only recently been licensed in the UK for the treatment of RA. In the USA methotrexate is often preferred to traditional slow-acting antirheumatics such as gold, sulphasalazine and penicillamine. We examine the evidence.