The Journey of Methotrexate and Potential Alternative Pharmacotherapies for Rheumatoid Arthritis.

Abstract

Rheumatoid Arthritis (RA) is a systemic inflammatory auto-immune disorder chiefly described by synovitis followed by extra-articular manifestations of organ association such as pneumonia in addition to the clinical symptoms that cause long-term joint damage starting from the small joints and gradually progressing to the larger ones. Early diagnosis is considered a major improvement for the most desirable outcomes. Methotrexate (MTX), an antifolate, has been the gold standard therapy in use for over forty years as an anchor drug. This drug started out as an anti-cancer drug in large doses and is now in use to treat rheumatoid arthritis at very low doses. The treatments for rheumatoid arthritis aim to curb the swelling in the body and protect the joints from further damage. Recent research has seen an increase in the use of combination therapies with Methotrexate. In this paper, we present a summary of the current drug in use and its side effects, associated with RA. The paper gives an account of alternate modes of treatment that have been explored for the treatment of rheumatoid arthritis. Initially designed to inhibit the enzyme dihydrofolate reductase and treat various types of cancer, methotrexate found application as an anti-rheumatic drug in 1984 although suggestions for the same have been made since the 1950s. Since then, a substantial amount of clinical evidence has been obtained to clearly indicate the cytotoxic activity of the drug against the cells responsible for joint inflammation associated with RA. Thus, methotrexate is a clear choice when it comes to treating RA despite the advent of other lines of treatment being explored and implemented.