REVIEW - MTX - how does it really work?

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Nat Rev Rheumatol. 2010 Mar;6(3):175-8.

Methotrexate--how does it really work?

Chan ES, Cronstein BN.

Department of Medicine, New York University School of Medicine, 550

First Avenue, NBV16N1, New York, NY 10016, USA.

Abstract

Methotrexate remains a cornerstone in the treatment of rheumatoid

arthritis and other rheumatic diseases. Folate antagonism is known to

contribute to the antiproliferative effects that are important in the

action of methotrexate against malignant diseases, but concomitant

administration of folic or folinic acid does not diminish the

anti-inflammatory potential of this agent, which suggests that other

mechanisms of action might be operative. Although no single mechanism

is sufficient to account for all the anti-inflammatory activities of

methotrexate, the release of adenosine from cells has been

demonstrated both in vitro and in vivo. Methotrexate might also confer

anti-inflammatory properties through the inhibition of polyamines. The

biological effects on inflammation associated with adenosine release

have provided insight into how methotrexate exerts its effects against

inflammatory diseases and at the same time causes some of its

well-known adverse effects. These activities contribute to the complex

and multifaceted mechanisms that make methotrexate efficacious in the

treatment of inflammatory disorders.

PMID: 20197777

http://www.ncbi.nlm.nih.gov/pubmed/20197777

Not an MD