M ethotrexate is an old anti-cancer drug and a real poison. By killing enough immune cells, immune-mediated inflammation can be reduced. M ethotrexate may cause liver toxicity, lung problems, mouth ulcers, stomach ulcers. Obviously, if you kill too many immune cells you are at risk of getting a life-threatening infection. A good drug is prednisone, but it is seldom used because it has long-term side effects, which scare both physicians and patients.
Osteoporosis is on of the most feared long-term effects of steroid use.
If the dose of prednisone is more than 7.5 mg per day over six months, a bone scan should be done. If bone density is decreased, treatment with etidronate and calcium may prevent bone loss and permit the continued use of steroid therapy. P rednisone is the preferred agent because its cheap and effective. All inflammation is likened to a fire. You get out the fire extinguishers and go to work.