Methotrexate
Methotrexate is a folic acid analog used extensively for the treatment of RA. It appears that its ability to inhibit dihydrofolate reductase is nor responsible for its efficacy in RA, however. Instead, activity may be related to effects on aminoimidazole-carboxamide ribotide transformylase, leading to the release of adenosine, a potent anti-inflammatory molecule that inhibits neutrophil adherence to fibroblasts and endothelial cells. Methotexate inhibits IL-1 and increases the expression of TH2 cytokines (eg IL4), leading to decreased production of TH1 cytokines (eg IFN-γ)
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