The unsung hero of the RA revolution

Rheumatoid arthritis has undergone a paradigm shift over the past two decades - and it's not entirely down to biologics.

A review of six years of articles in major rheumatology journals reveals a big driver of better disease control has been higher doses of methotrexate (MTX).

The drug is now given at a mean dose of 20-25mg a week, and many clinicians give parenteral MTX to get doses up.

"When I was a registrar, methotrexate doses were 5 to 7.5 milligrams