Treatment approaches for rheumatoid arthritis may include a combination of medications, supportive therapies, and surgery. Doctors commonly prescribe chemotherapy drugs, such as methotrexate, for people with this condition.

People typically associate chemotherapy with cancer treatment. However, doctors often use chemotherapy drugs to treat individuals with autoimmune conditions such as rheumatoid arthritis (RA).

Doctors classify methotrexate and other chemotherapy medications as disease-modifying anti-rheumatic drugs (DMARDs). This is because these drugs block the actions of the immune cells that attack healthy joints, which helps to prevent damage and slow down progression of the disease.

In this article, we discuss these medications for the treatment of RA and how they work. We also cover the side effects and risks of this treatment.

A man receiving chemo for rheumatoid arthritis.Share on Pinterest
Doctors may prescribe chemotherapy drugs to slow the progression of RA.

Many people understand the function of chemotherapy drugs when it comes to cancer.

Doctors prescribe chemotherapy drugs to kill cancer cells or to prevent them from growing and spreading to other parts of the body. There are a number of different types of chemotherapy drugs for cancer.

Certain chemotherapy drugs, such as methotrexate, are also a common treatment option for autoimmune conditions, such as RA.

Doctors typically prescribe these drugs at much lower dosages for people with RA than they would for those with cancer. This is because the goal of treatment is not to kill cancer cells but to change the behavior of the overactive immune cells.

The lower dosage also helps to reduce the severity of potential side effects.

Early treatment with chemotherapy drugs can help slow the progression of RA and reduce or prevent joint damage and other serious complications.

Chemotherapy drugs that doctors may recommend for treating people with RA include:


Methotrexate is one of the first-line treatment options for people with RA. Doctors consider it to be an effective treatment with typically minimal side effects.

People usually take methotrexate once weekly, either by mouth or injection. Doctors will also recommend taking a folic acid supplement to help reduce the chances of more serious side effects.

According to the American College of Rheumatology, people usually first see an improvement in RA symptoms within 3–6 weeks of starting treatment. However, they may not begin to see the full benefit of methotrexate until after 12 weeks.


Cyclophosphamide is a potent chemotherapy drug that can cause more severe side effects than methotrexate. Doctors typically only use this medication to treat severe complications of RA, specifically vasculitis, which is inflammation in the blood vessels.


Azathioprine works by suppressing the immune system, which may help some people with RA.

Doctors do not commonly prescribe azathioprine for RA because it is not especially helpful for joint inflammation. However, there may be some cases where it is used to manage disease outside the joints.

RA involves inflammation that damages people’s joints over time, which can lead to pain, stiffness, and reduced mobility. This inflammation occurs due to an overactive immune system that is attacking the body’s tissues.

In people with RA, the immune system mistakes healthy tissue in the joints for foreign invaders. It sends cells to attack the joints, which causes them to become inflamed and painful.

Chemotherapy drugs help treat RA by blocking or interfering with the actions of these immune cells, which helps to prevent joint damage and slow down progression of the disease.

It is essential to understand that doctors typically prescribe a much lower dosage of chemotherapy drugs for people with RA than for those with cancer. In cancer treatment, the higher dosage has a stronger impact on the body and can cause more severe side effects.

At a lower dosage, chemotherapy drugs, such as methotrexate, are similar to other DMARDs that doctors prescribe for RA.

Share on Pinterest
Chemotherapy drugs can cause side effects, including reduced appetite, nausea, and vomiting.

Although doctors usually prescribe chemotherapy drugs at lower dosages for RA, the treatment can still cause side effects.

People should report any side effects to their doctor, who may recommend adjusting the dosage or switching to another drug with more manageable side effects. They may also prescribe other medications to help treat or prevent side effects.

Chemotherapy drugs can affect blood cell production in the body, which may lead to lower counts of red blood cells, white blood cells, or platelets.

Side effects of methotrexate can include:

However, many people find that taking a folic acid supplement along with methotrexate will reduce the severity or prevent some of these side effects. Doctors will recommend regular blood tests to check for signs of problems while taking methotrexate.

People should see their doctor right away for more serious side effects, which can include:

  • dizziness
  • blurred vision
  • diarrhea
  • bloody stool
  • bloody vomit
  • shortness of breath
  • swelling in the legs

Doctors commonly use methotrexate and other chemotherapy drugs to treat autoimmune conditions such as RA. These drugs can help relieve symptoms and prevent further damage to joints. However, a person may not begin to notice any improvement until several weeks of commencing treatment.

Chemotherapy drugs can cause a number of side effects, ranging from mild to severe. However, most people tolerate methotrexate well.

People should discuss any side effects with their doctor, who may suggest adjusting the dose or switching to another medication. Doctors may also recommend regular appointments to check for signs of more serious side effects.