Chemical Synthetic Disease Modifying Drugs (csDMARD) Used forRheumatoid Arthritis

Methotrexate (MTX) is a conventional synthetic DMARD used for treating rheumatoid arthritis by blocking folate reduction, which affects cell division and reduces T-cell activation and cytokine production. While it effectively suppresses inflammation by increasing adenosine activity, it can also lead to side effects such as bone marrow depression, hair loss, and liver fibrosis. MTX is typically administered at a starting dose of 7.5-10 mg/week, with potential increases based on tolerance and response, up to a maximum of 25-30 mg/week. Subcutaneous administration is preferred over oral due to better bioavailability and fewer gastrointestinal side effects. The review highlights the importance of MTX in developing countries where biological treatments are less accessible due to cost, emphasizing the challenges faced by physicians in managing rheumatoid arthritis with limited resources.