Methotrexate: DMARD of 1st choice Folate antagonist Potent immunosuppressant and anti-inflammatory action Beneficial effects in RA are probably related to inhibition of cytokine production, chemotaxis, and cell-mediated immune reaction. Induction of oral low-dose 7.5-15mg) weekly MTX regimen has improved acceptability of this drug in RA. The onset of symptoms relatively rapid (4-6 weeks), therefore preferred for initial treatment. Mtx is now the Drug of first choice and the standard treatment for most patients, including cases of juvenile RA. ESSENTIALS OF MEDICAL PHARMACOLOGY;7TH EDITION;KD TRIPATHI;PAGE NO 211