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How do I know if methotrexate is working for rheumatoid arthritis?

Medically reviewed by Philip Thornton, DipPharm. Last updated on Aug 19, 2022.

Official answer


Methotrexate is an immunosuppressant drug that is used to treat rheumatoid arthritis, an autoimmune disease, as well as other inflammatory conditions. It works to reduce the inflammation, pain, swelling, redness, morning stiffness, fatigue and other symptoms associated with rheumatoid arthritis.

Methotrexate also slows down how quickly rheumatoid arthritis progresses and damages joints, which is why it belongs to a group of drugs known as disease-modifying anti-rheumatic drugs (DMARDs).

To tell if methotrexate treatment is working for your rheumatoid arthritis:

  • Your doctor will conduct regular blood tests and check-ups
  • You can keep a track of your symptoms and looks for signs of improvement
  • Imaging tests, such as x-rays and musculoskeletal ultrasound (MSUS), may be used

Blood tests and check-ups are used to tell you if methotrexate is working for rheumatoid arthritis

When you first start treatment with methotrexate your doctor will conduct blood tests and check-ups every 1-2 weeks. The results from these tests will help you to know whether methotrexate is working for you and also if it’s causing side effects.

Based on the results of your tests your doctor may adjust the dose of methotrexate you take until this medication is working well for you. Once you are on a dose that is working for you, blood tests and check-ups are usually conducted every 2 to 3 months.

Blood tests that help to determine how active your rheumatoid arthritis is and show whether methotrexate is working for you include:

  • Erythrocyte sedimentation rate (ESR) test - measures the amount of inflammation in your body by measuring how fast red blood cells cling together and settle on the bottom of a test turn over the course of one hour
  • C-reactive protein (CRP) test - also measures inflammation by measuring CRP, which is a protein produced by the liver when there is inflammation somewhere in your body
  • Multibiomarker Disease Activity (MBDA, Vectra DA) test - measures 12 biomarkers )including proteins, hormone and growth factors) to provide a single measure of disease activity. It can help to determine the aggressiveness of your disease and likelihood of a symptom flare-up should your medications change.

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You’ll also know if methotrexate is working for you because your rheumatoid arthritis symptoms will start to improve

You may notice a reduction in your rheumatoid arthritis symptoms in as little as 3 to 6 weeks after starting treatment with methotrexate, but it can take up to 12 weeks after starting on a dose that works well for you for the full effects of the drug to be seen.

If methotrexate is working for you, you’re likely to experience fewer swollen and painful joints, less morning stiffness and be able to move about and perform daily activities more easily.

It’s important to remember that during the first weeks and months of treatment you may not notice any benefit in terms of improvement in your symptoms, but this does not mean this medication won’t work for you in time.

If methotrexate does not work well enough on its own, it can also be combined with painkillers, other DMARDs, and biological drugs to provide symptom relief.

Imaging tests can tell you if methotrexate is working to prevent joint damage

Imaging tests, including x-rays, MSUS and magnetic resonance imaging (MRI), are used to diagnose rheumatoid arthritis and can also be used to check for worsening joint damage while you’re on methotrexate.

These radiographic tests are used to detect inflammation, bone erosions and joint space narrowing, which indicate that rheumatoid arthritis is damaging your joints. MUSU and MRI are better at picking up bone erosion and inflammation than x-rays.

When methotrexate works it helps to slow joint damage and the progression of rheumatoid arthritis. In some people taking methotrexate, no or limited damage may be picked up on these tests (radiographic progression). However, methotrexate isn’t always able to prevent disease progression, especially in people with severe rheumatoid arthritis.


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