Toward a better understanding of methotrexate

In spite of the fact that MTX has become the most widely prescribed DMARD, clinical prescribing behaviors are often habitual and frequently reflect patterns learned at a time when less was understood about the metabolism of the drug, reasons for toxicity, or possible means of overcoming resistance. Since most of the insights regarding the use of MTX and its effects on cellular metabolism are derived from the oncology literature, it is apparent that rheumatologists are in the debt of these researchers, and that similar observations should be sought when the drug is used in the long-term treatment of patients with rheumatic diseases. Rheumatologists are usually well informed about the many clinical issues associated with the use of MTX, but clinical decisions may frequently be enhanced by a sound understanding of the complexities of the drug's cellular metabolism. These insights can contribute to more effective, safer, and more satisfying practice patterns.