A Review on Methotrexate Used in Rheumatoid Arthritis

Since the 1980s, methotrexate has been used to treat rheumatoid arthritis (RA), and it is still frequently used as the first medicine to treat RA. In this review, we look at a variety of theories to help us understand how methotrexate works to treat RA. Among them are the antagonistic effects of folate, adenosine signaling, the production of reactive oxygen species (ROS), the reduction of adhesion molecules, the changing of cytokine profiles, and the suppression of polyamines. The methotrexate mechanism in RA is currently most commonly explained via adenosine signaling. As a result of methotrexate's ability to raise adenosine levels and the activation of an intracellular cascade by adenosine's interaction with extracellular receptors, which reduces inflammation overall. In addition to these theories, we also take into account some of the more recent genetic indicators of methotrexate efficacy and toxicity in RA as well as the mechanism of methotrexate in RA from the standpoint of its negative consequences. Finally, we briefly go over how methotrexate works in combination with TNF-inhibitors to treat RA. Ultimately, developing more effective treatments with fewer adverse effects may be possible if the pathway and mechanism leading to methotrexate efficacy in RA are clearly understood.