[Methotrexate treatment of rheumatoid arthritis]

Weekly low dose methotrexate has a beneficial efficacy: toxicity ratio compared to other disease-modifying antirheumatic drugs. Methotrexate shows one of the most pronounced effects on disease activity, with improvement of functional status and slowing of radiological progression of joint destruction. In addition, the short- and medium-term withdrawal rate is low and due to usually minor side effects. However, major complications such as interstitial pneumonitis, hepatic fibrosis and osteopathy deserve special attention, in particular during long-term treatment. Careful patient selection and monitoring, in close cooperation between the rheumatologist and general practitioner, contribute to optimal security of methotrexate treatment. The present overview summarizes scientific data and makes practical recommendations.