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.

在过去的几十年里，类风湿性关节炎 (RA) 初始治疗的标准护理一直是甲氨蝶呤。甲氨蝶呤作为单一疗法和与常规、生物和靶向合成疗法联合使用是有效的。甲氨蝶呤通常具有良好的耐受性，但具有重要但不常见的潜在副作用，包括肝毒性和血细胞减少的风险。一些研究表明，对脂肪肝患者进行更积极的监测可能是合适的。有了令人放心的安全数据，更快速的剂量增加和皮下治疗的使用可能会带来更大的成功。一些脱靶的好处，例如降低心血管疾病的风险也已经得到证明，尽管这些研究可能会受到混淆。最近公布的指南继续支持甲氨蝶呤作为一线治疗。甲氨蝶呤是一种低成本、安全且有效的 RA 疗法，不应忽视也不应过早放弃。