METHOTREXATE - THE EMERGING DRUG OF CHOICE FOR SERIOUS RHEUMATOID-ARTHRITIS

The recently recognized high morbidity and unexpected mortality associ ated with rheumatoid arthritis (RA) has spurred new interest in more a ggressive, early treatment of this disease. Methotrexate (MTX) has rap idly become the rheumatologist's drug of choice for serious RA because of its favorable efficacy to toxicity ratio and rapid onset of action compared with other second-line agents. The initial concerns about he patic fibrosis and cirrhosis in psoriatic patients has subsided somewh at as long-term liver toxicity data are accumulating in patients with RA. Routine liver biopsy with incremental doses of MTX is no longer re commended. Potential for severe lung, hematologic, and infectious comp lications exists, mandating careful monitoring of RA patients taking M TX.