Methotrexate has been established beyond doubt as the primary disease-modifying drug for the therapy of rheumatoid arthritis. The value of methotrexate is also reflected by its gold standard position in most national as well as international guidelines, including the most recent from EULAR and ACR. Also, methotrexate is considered the anchor drug for combination therapies with other small molecules and the majority of biologic agents. Although originally developed as an oral drug, the subcutaneous application had demonstrated in various studies several advantages, including heightened bioavailability and improved efficacy without an altered or more severe side effect profile. Methotrexate is the best studied drug with a well-known safety profile and monitoring scheme. Furthermore, the subcutaneous application of methotrexate has been associated with a delay of the use of biologic agents. In this symposium four experts of rheumatology will give an update on the use of MTX the optimized way in RA therapy.
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