Class Explorer · Pain & inflammation
Conventional DMARDs
Disease-modifying agents that slow the immune process itself rather than treating its symptoms. Slow to work, and monitored for as long as they are taken.
Members
MethotrexateWeekly. The single most important word about this drug.HydroxychloroquineThe gentlest DMARD, with a toxicity that only shows up in the eye.
Also in this class: Sulfasalazine · Leflunomide · Azathioprine. Full pages arrive as the library grows.
Compare the members
Methotrexate
- Schedule
- Once weekly
- Signature monitoring
- CBC, liver, renal
Hydroxychloroquine
- Schedule
- Daily
- Signature monitoring
- Annual retinal screening
Shared across the class
- Indications
- Rheumatoid arthritis · Systemic lupus erythematosus · Psoriatic arthritis · Inflammatory bowel disease (some agents)
- Adverse effects
- Agent-specific organ toxicity · Infection risk (methotrexate)
- Contraindications
- Pregnancy (methotrexate, absolutely) · Significant liver disease (methotrexate)
- Monitoring
- Methotrexate: CBC, liver enzymes and creatinine, roughly every 8 to 12 weeks once stable · Hydroxychloroquine: baseline and then annual retinal screening after five years · Infection symptoms and vaccination status
What makes each agent different
- Methotrexate is the anchor drug of rheumatoid arthritis: effective, cheap, and dangerous if the weekly schedule is misunderstood.
- Hydroxychloroquine is the mildest of them, safe in pregnancy, and the backbone of lupus therapy; its toxicity is ocular and cumulative rather than acute.
Methotrexate for inflammatory disease is WEEKLY. Daily administration has killed patients, and it remains one of the most reported serious medication errors in the world.
Folic acid alongside methotrexate reduces mucositis and gastrointestinal effects without abolishing efficacy; it is standard, not optional.
Last reviewed 2026-08-16 · Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed.