The risk with modern dosing regimens: Lower doses, weekly schedules, and concomitant folic acid is less clear. Multiple serious adverse events have been attributed to methotrexate, based largely on older reports using high or daily doses, and subsequent case reports and circumstantial evidence. Methotrexate is generally well tolerated but can cause symptomatic adverse events. Use in rheumatoid arthritis infers a significant morbidity and mortality benefit. It is effective in controlling disease activity and preventing disease-related damage, and significantly cheaper than many alternatives. Methotrexate is the first line drug treatment for a number of rheumatic and non-rheumatic diseases.
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