Which medication did you start with, and how do methotrexate and sulfasalazine compare?
Methotrexate is the most common starting treatment for RA. Around 60 percent of people with RA are currently taking or have taken methotrexate, and it's recommended as the first-line treatment by rheumatology experts. Eventually, up to Show Full Answer
Which medication did you start with, and how do methotrexate and sulfasalazine compare?
Methotrexate is the most common starting treatment for RA. Around 60 percent of people with RA are currently taking or have taken methotrexate, and it's recommended as the first-line treatment by rheumatology experts. Eventually, up to 90 percent of people with RA are prescribed methotrexate at some point.
Both medications can be effective, but methotrexate is generally considered the gold standard for RA treatment and has been widely prescribed since the 1980s.
Effectiveness:
Methotrexate works by calming the immune system and reducing inflammation. It may take 3-6 weeks to start improving symptoms and up to 12 weeks for full effects. For some people, methotrexate alone controls their RA, while others need it combined with other medications.
Sulfasalazine is another DMARD option that can be effective, and it's sometimes used in combination therapy with methotrexate.
Side Effects:
Common methotrexate side effects include:
- Nausea and vomiting
- Fatigue
- Mouth sores
- GI issues
Taking folic acid alongside methotrexate can reduce these side effects by 79 percent. A myRAteam member shared that taking increased folic acid eliminated their mouth sores.
Sulfasalazine, when combined with NSAIDs, might increase the risk of stomach bleeding and could be toxic to blood and bone marrow.
Your rheumatologist can help determine which medication suits you best based on your individual response and side effects.
December 4, 2025
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