SC Methotrexate Benefits — SCE Rheumatology MCQ

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EasyRheumatoid ArthritisSC Methotrexate BenefitsSCE Rheumatology

A 55-year-old man with RA has achieved stable low disease activity on Methotrexate 15 mg subcutaneous weekly. He asks whether subcutaneous Methotrexate has advantages over oral beyond bioavailability. What additional benefit does SC administration offer?

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Correct answer: B — Reduced gastrointestinal side effects (nausea vomiting) compared with oral Methotrexate at equivalent doses

Subcutaneous Methotrexate causes significantly less gastrointestinal toxicity (nausea vomiting abdominal pain) compared with oral Methotrexate at equivalent doses. This is because SC administration bypasses first-pass hepatic metabolism and avoids direct GI mucosal exposure. BSR 2025 csDMARD guidelines and EULAR 2022 recommendations suggest considering SC Methotrexate when patients experience GI intolerance to oral formulation or when higher doses (>15 mg) are needed (where oral bioavailability plateaus). Switching from oral to SC can effectively salvage patients who would otherwise fail Methotrexate due to intolerance.

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