Methotrexate (MTX) is first-line drug recommended for rheumatoid arthritis (RA). However, despite more than two decades of experience with the drug, considerable heterogeneity exists in rheumatologists. This reports suggeted that, optimal MTX is more efficacious than non-optimal dose for treatment of RA, with no impact on radiological progression over 2 years.

Although Methotrexate (MTX) is the consensual first-line disease-modifying antirheumatic drug (DMARD) for rheumatoid arthritis (RA), substantial heterogeneity remains with its prescription and dosage, which are often not optimal. To assess the symptomatic and structural effect of optimal Methotrexate (MTX) dose among individuals with early RA in daily clinical over two years.

The evaluation of patients who completed the ACR-EULAR (American College of Rheumatology/European League against Rheumatism) criteria for RA and obtained MTX as a first DMARD. Optimal MTX dose was prescribed as ≥10 mg/week through the first three months, with a rise to ≥20 mg/week or 0.3 mg/kg/week at six months without Disease Activity Score in 28 joints remission. By adjusting appropriate variables, generalised logistic regression was used to estimate symptomatic and structural effectiveness with and without optimal MTX dose.

A total of 314 individual with RA obtained MTX within the first year of follow-up. The optimal MTX dose was received only by 26.4% of the patients. Optimal as compared to non-optimal MTX dose was more effective in gaining ACR-EULAR remission at one year and normal functioning, with no influence on radiological progression after adjustment. Outcomes were correlated during the second year.

Optimal MTX dose is more effective than for function and remission in early arthritis during daily practice, with no influence on radiological progression across two years.