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Rheumatoid Arthritis — SCE Rheumatology MCQ

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ModerateRheumatoid ArthritisRheumatoid ArthritisSCE Rheumatology

A 42-year-old woman with RA treated with Methotrexate 25 mg weekly is stable with DAS28-CRP of 2.2. She asks whether the route of administration matters. She currently takes oral Methotrexate. According to evidence which route has better bioavailability?

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Correct answer: A — Subcutaneous has better bioavailability particularly above 15 mg weekly

Subcutaneous Methotrexate has superior and more consistent bioavailability compared with oral Methotrexate, particularly at doses above 15 mg weekly. Oral bioavailability plateaus at approximately 15 mg due to saturable intestinal absorption. BSR 2025 csDMARD guidelines and EULAR 2022 recommendations acknowledge that switching from oral to subcutaneous Methotrexate can improve efficacy and reduce GI side effects. This should be considered before assuming Methotrexate failure and escalating to biologic therapy.

Reference: BSR 2025 csDMARD guidelines; Schiff MH et al 2014 SC vs oral MTX bioavailability