Which drug class is commonly used as the cornerstone DMARD in rheumatoid arthritis?

Which drug class is commonly used as the cornerstone DMARD in rheumatoid arthritis?

• A. Leflunomide
• B. Methotrexate
• C. Hydroxychloroquine
• D. Sulfasalazine

Answer: (B)

Methotrexate is used as the foundation for treating rheumatoid arthritis because it provides strong, proven control of disease activity and slows joint damage, often working well as a single agent or in combination with biologics. At low weekly doses, it broadly modulates the immune response—folate antagonism reduces rapid immune cell proliferation, and increased adenosine production adds anti-inflammatory effects—leading to meaningful improvement in symptoms and radiographic outcomes. Its safety profile at these low doses is generally favorable, especially when paired with folic acid to lessen mucosal and hepatic toxicity. Start with a low weekly dose and titrate as needed, with routine monitoring of liver enzymes, blood counts, and renal function, plus counseling about potential pregnancy risks and drug interactions. While other DMARDs like leflunomide, hydroxychloroquine, and sulfasalazine are also used in rheumatoid arthritis, they are typically adjuncts or alternative options, not the primary anchor therapy.

Methotrexate is used as the foundation for treating rheumatoid arthritis because it provides strong, proven control of disease activity and slows joint damage, often working well as a single agent or in combination with biologics. At low weekly doses, it broadly modulates the immune response—folate antagonism reduces rapid immune cell proliferation, and increased adenosine production adds anti-inflammatory effects—leading to meaningful improvement in symptoms and radiographic outcomes. Its safety profile at these low doses is generally favorable, especially when paired with folic acid to lessen mucosal and hepatic toxicity. Start with a low weekly dose and titrate as needed, with routine monitoring of liver enzymes, blood counts, and renal function, plus counseling about potential pregnancy risks and drug interactions. While other DMARDs like leflunomide, hydroxychloroquine, and sulfasalazine are also used in rheumatoid arthritis, they are typically adjuncts or alternative options, not the primary anchor therapy.