Is arava better than methotrexate?

If you’re dealing with rheumatoid arthritis (RA), then there’s a good chance that you’ve been offered the choice of taking arava or methotrexate. Well, look no further because we’ll help you decide which one is better! And don’t worry, it won’t be boring – we’ll keep it light and funny!

What are Arava and Methotrexate?

Before we dive into the nitty-gritty stuff about these two drugs, let’s first get to know them by their full names. Arava is leflunomide while methotrexate (MTX) is…well…methotrexate.

Both medications are commonly prescribed for patients suffering from RA to help manage the inflammation and pain caused by this chronic condition. They work by suppressing your immune system in order to prevent your body from attacking its own healthy tissues.

While both have relatively similar mechanisms of action, they differ in terms of their efficacy for different symptoms as well as side effects. Let’s take a closer look at each one:


Arava falls under the category of “disease-modifying antirheumatic drugs” or DMARDs for short – not exactly something easy to remember if you’re not used to medical jargon! It works by inhibiting an enzyme called dihydroorotate dehydrogenase involved in making DNA precursors – just imagine it like putting handcuffs on that sneaky guy so he doesn’t make any trouble.

Because arava primarily targets immune cells linked specifically with RA symptoms rather than other parts of the body (as opposed to nonsteroidal anti-inflammatory medication or NSAIDs), this means less likelihood for generalized immunosuppression complications such as infections, allergies / gut disturbances etc.

However, some studies suggest that adverse events were more common among users compared to methotrexate. One of the most common side effects is an upset stomach, which may cause nausea, vomiting or diarrhea.


MTX also works as a DMARD by blocking some steps in DNA synthesis altogether – kind of like letting your garden dry out so weeds don’t sprout. It’s considered the gold standard treatment for RA (even though it has been around since 1982), and also prescribed at lower doses to treat other autoimmune conditions such as psoriasis or Crohn’s disease.

One great benefit of MTX is that it can be administered not only orally but subcutaneously or intramuscularly, providing options for different patient preferences/situations. On occasions oral option might result in too much variability/swings in blood levels especially with meals interfering/not punctual intake etc causing therapeutic failure.

Compared to arava, adverse events may happen less often when taking methotrexate provided monitoring guidelines are followed properly and reviewed frequently – this is where visiting / video consulting regularly with your clinician comes into play-. Side effects from MTX range from mild hair loss to serious lung damage if prolonged high-doses are used carelessly over time.

Which one Should You Choose?

It’s hard to determine whether Arava or Methotrexate tends toward effectiveness on a clinical level – they both have their pros and cons. In general terms though,

  • If you’re not responding well enough to NSAIDs alone then ask your clinician about trying one active principle first before changing compounds entirely,
  • The switch between drugs via personalization should target the symptoms you experience more severely [but never forget efficacy/safety balancing].
  • For instance there are cases where switching patients unsuccessfully managed on methotrexate solely onto additional biologic agents (“biologics”) helped recover mobility better than converting all treatments including stopping MTX fully.

In any case remember that every patient experiences RA differently, so what may work for one person might not be the same for another. Do not simply double up on doses and hope just like that – it can be dangerous – regardless of whether you are taking arava or methotrexate!

As with all drugs, there will always be pros and cons to weigh (even if we wish it was a no-brainer decision), but your clinician’s advice is key. They should offer guidance on both clinical effectiveness/ potential adverse reactions from therapeutic options based on their diagnostic expertise/experience in different medication management pathways/regimens.


Deciding which RA drug to take can feel overwhelming given the possible differences in efficacy/sider effects between candidates such as arava or methotrexate when considering how individualized each treatment strategy is according to patients’ symptoms / previous therapy record etc.

Methotrexate has carried the gold-standard-medicine title amongst DMARDs successfully over the years; while this doesn’t mean that alternatives like Leflunomide aren’t effective necessarily or shouldn’t get used at some point during your disease course, newer treatments have emerged often working hand by hand with broadly tolerated MTX itself. Plus Leufonamide isn’t any cheaper than ever-present generic types making financial considerations also important if choosing stand-alone therapies.

It’s worth giving new options an honest try under medical supervision rather than mere independent experimentation ignoring advanced Science-based alternative possibilities!

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