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Methotrexate (MTX) — the most misunderstood yet most effective DMARD in rheumatology: ⸻ Busting Myths About Methotrexate (MTX) An essential guide for General Practitioners ⸻ 1️⃣ Myth: Methotrexate is a ‘chemotherapy drug’, hence dangerous. Truth: •The doses used in rheumatology (7.5–25 mg/week) are 10–100 times lower than in cancer chemotherapy. •Low-dose MTX works not by killing cells, but by increasing adenosine, a natural anti-inflammatory molecule. •It is not technically an immunosuppressant in rheumatology. ⸻ 2️⃣ Myth: Methotrexate causes severe liver damage. Truth: •Liver toxicity is rare with proper monitoring (LFT every 2–3 months). •Alcohol use, obesity, or fatty liver are higher risks — not the drug alone. •MTX can be safely continued for years, even lifelong in many cases. ⸻ 3️⃣ Myth: Methotrexate causes blood count drops (cytopenias) easily. Truth: •MTX rarely causes cytopenias if: •Folic acid is supplemented regularly (5–7 mg/week, not on MTX day) •No underlying infection, renal failure, or other acute illness •Pancytopenia is exceedingly rare in well-selected, monitored patients. ⸻ 4️⃣ Myth: MTX causes infertility or birth defects in all cases. Truth: •Women: Should avoid pregnancy only during treatment and for 2-3 months after stopping. •Men: Most guidelines allow continuation; some recommend stopping 3 months before conception. •Not a lifelong fertility ban. ⸻ 5️⃣ Myth: MTX should be stopped as soon as patient improves. Truth: •MTX is a controller drug, not a painkiller. •Stopping too early = high risk of flare and joint damage •Maintain long-term unless contraindicated. ⸻ Bonus Myth: “It’s too toxic for elderly or long-term use.” Truth: •With dose adjustment and lab monitoring, MTX is safe across age groups. •It may reduce the need for steroids and surgeries! ⸻ BOTTOM LINE for GPs: Methotrexate is the cornerstone of rheumatology care. Used correctly, it is: •Safe •Well-tolerated •Life- and joint-saving Don’t let outdated fears prevent early referral or continuation in stable patients. ⸻ #medtwitter #nirjaramultisoecialityclinic #freedomfrompain