How Methotrexate Works

Rheumatoid arthritis is an autoimmune disease where the immune system mistakenly attacks the joints. Methotrexate works by modulating the immune system, reducing the release of inflammatory chemicals. At the low weekly doses used in rheumatology, methotrexate helps to control joint pain and swelling while slowing down disease progression.

Starting treatment early is key. Learn more about Pure Rheumatology London's early rheumatoid arthritis diagnosis and rapid treatment.

Safety Profile and Blood Monitoring

Methotrexate is effective and safe when monitored carefully. Because it can affect the liver, bone marrow, and lungs, your rheumatologist will arrange regular blood tests to check liver function, kidney function, and blood counts.

For patients with both rheumatoid arthritis and osteoporosis, other treatments such as Zoledronate IV infusion may also be recommended.

• Folic acid is prescribed alongside methotrexate to reduce side effects.
• Alcohol intake should be kept low to protect liver health.
• Regular reviews ensure safe, long-term use.

Common Side Effects

Like all medicines, methotrexate can cause side effects, but most are manageable. These may include:

• Mild nausea or stomach upset
• Mouth ulcers or fatigue
• Changes in liver function tests

Serious side effects such as lung inflammation or very low blood counts are rare and monitored closely through routine follow-up and testing.

Methotrexate vs Biologics: What’s the Difference?

Methotrexate (MTX) is a conventional DMARD taken once weekly (tablet or injection). It damps down immune overactivity, often used as first-line therapy and as a foundation drug with other treatments.
Biologic therapies (e.g., anti-TNF, IL-6 inhibitors) are targeted medicines made from proteins that block specific parts of the immune system. They’re given by injection or infusion at set intervals.

Why Choose Pure Rheumatology London

At Pure Rheumatology London, consultant rheumatologist Dr Naveen Bhadauria provides expert care in prescribing and monitoring methotrexate. With personalised treatment plans, ongoing blood test monitoring, and access to advanced therapies, they ensure patients receive safe and effective rheumatoid arthritis treatment in London.

Key differences (at a glance):

• Onset: MTX typically helps within 4–6 weeks, with full effect by ~3 months; some biologics act faster once started.
• When used: MTX is usually first-line; biologics are considered when MTX is insufficient or not tolerated.
• Combination: Many patients do best with MTX + a biologic (your rheumatologist will advise).
• Monitoring: Both require regular blood tests; biologics also need infection screening prior to starting.
• Administration: MTX = weekly tablet/auto-injector; biologics = pre-filled pen or IV infusion at clinic-set intervals.
• Side effects: Profiles differ; your clinician will tailor therapy to your health, lifestyle, and risk factors.

Tip: If you’re at the start of your journey, early assessment helps match the right treatment to your goals, see the Pure Rheumatology page on early rheumatoid arthritis diagnosis and rapid treatment.

When Methotrexate May Not Be Suitable

Methotrexate is widely used and safe with monitoring, but it may not be appropriate if any of the following apply (your rheumatologist will advise):

• Planning pregnancy, pregnant, or breastfeeding (specialist pre-conception advice is essential).
• Significant liver disease or high alcohol intake that cannot be reduced.
• Severe kidney impairment.
• Pre-existing lung disease or history of methotrexate-related lung issues.
• Very low blood counts or certain blood disorders.
• Active infection or poorly controlled chronic infections.
• Previous intolerance or adverse reaction to methotrexate despite dose/formulation adjustments.

If methotrexate isn’t suitable or isn’t controlling symptoms well, your clinician may discuss combination DMARDs, biologic therapies, or targeted synthetic DMARDs (e.g., JAK inhibitors), chosen to fit your medical history, monitoring needs, and lifestyle.

Book Your Private Consultation

If you are experiencing arthritis, autoimmune symptoms, or persistent musculoskeletal pain, early diagnosis and treatment can make all the difference.

Book an appointment today with Dr Naveen Bhadauria.

Specialist rheumatology care in a world-class setting is just one consultation away.

Contact Pure Rheumatology London now to arrange your private consultation.

Frequently Asked Questions about Methotrexate in Rheumatoid Arthritis

• How does methotrexate work in rheumatoid arthritis?

Methotrexate works by calming down an overactive immune system. It reduces inflammation in the joints and helps prevent long-term joint damage.

• Is methotrexate safe for long-term use?

Yes, methotrexate is safe for long-term use when monitored with regular blood tests. Your rheumatologist will check your liver, kidney, and blood counts to ensure safety.

• What are the most common side effects of methotrexate?

Common side effects include mild nausea, fatigue, and mouth ulcers. Folic acid supplements usually reduce these problems. Serious side effects are rare but monitored closely.

• Why do I need regular blood tests on methotrexate?

Blood tests help your rheumatologist check your liver and blood counts. This ensures that methotrexate remains safe and effective throughout treatment.

• Can I drink alcohol while taking methotrexate?

Alcohol intake should be kept to a minimum, as both alcohol and methotrexate can affect the liver. Always follow your rheumatologist’s advice.

• How long before methotrexate starts working for rheumatoid arthritis?

Methotrexate does not work immediately. Most patients begin to notice improvements in joint pain and stiffness after 4–6 weeks, with full benefits often seen by 3 months. Your rheumatologist will monitor your response and adjust treatment if needed.

• What alternatives exist if methotrexate doesn’t work?

If methotrexate alone does not fully control your rheumatoid arthritis, your rheumatologist may recommend:

• Combination therapy with other DMARDs
• Biologic treatments (such as anti-TNF injections)
• Targeted synthetic DMARDs (such as JAK inhibitors)

These options are tailored to your condition and medical history to achieve the best long-term control.

This information is general and not a substitute for personal medical advice. Your rheumatologist will tailor treatment and monitoring to you.

If you are concerned about your bone health, please contact Pure Rheumatology London on 0207 126 7264 and you will be booked in for a comprehensive bone health assessment.

Article by Dr. Naveen Bhadauria

Introduction to DEXA Scans

DEXA scans are a crucial tool in the field of bone health, providing invaluable insights for both patients and healthcare professionals. Let’s explore their importance in osteoporosis screening and diagnosis.

Importance in Osteoporosis Screening

DEXA scans play a vital role in osteoporosis screening, offering a non-invasive and accurate method to assess bone health. These scans provide early detection of bone loss, allowing for timely intervention and prevention strategies.

By measuring bone mineral density (BMD), DEXA scans help identify individuals at risk of osteoporosis before fractures occur. This proactive approach enables healthcare providers to implement preventive measures and lifestyle changes.

Regular DEXA screenings are particularly important for postmenopausal women and older adults, who are at higher risk of osteoporosis. Early detection through DEXA scans can significantly improve outcomes and quality of life for those at risk.

Key Role in Osteoporosis Diagnosis

In osteoporosis diagnosis, DEXA scans serve as the gold standard for assessing bone density. These scans provide quantitative data that helps healthcare professionals make accurate diagnoses and informed treatment decisions.

DEXA results are interpreted using T-scores, which compare an individual’s bone density to that of a healthy young adult. This standardised approach allows for consistent diagnosis across different healthcare settings.

By offering precise measurements of bone density in various body parts, DEXA scans enable healthcare providers to track changes over time and adjust treatment plans accordingly. This longitudinal data is invaluable in managing osteoporosis effectively.

How a DEXA Scan Works

Understanding the science behind DEXA scans and what to expect during the procedure can help alleviate any concerns patients may have about the process.

The Science Behind Bone Density Scan

DEXA (Dual-Energy X-ray Absorptiometry) scans use low-dose X-rays to measure bone mineral density. The technology relies on the principle that different tissues absorb X-rays at different rates.

During a DEXA scan, two X-ray beams with different energy levels are passed through the body. The amount of X-rays that pass through the bone is measured, allowing for the calculation of bone density.

This advanced imaging technique can differentiate between bone and soft tissue, providing accurate measurements of bone mineral content. The results are then compared to standardised values to determine the patient’s bone health status.

Step-by-Step: What to Expect

• Preparation: Patients are typically asked to wear comfortable clothing without metal fasteners. No special preparation is usually required.
• Positioning: The patient lies on a padded table while the DEXA machine passes over the body. Multiple scans may be taken of different areas, such as the hip and spine.
• Scanning Process: The actual scan is painless and quick, usually taking about 10-30 minutes depending on the areas being examined.
• Results: A radiologist interprets the results, which are then discussed with the patient by their healthcare provider.
• Follow-up: Based on the results, the healthcare provider may recommend lifestyle changes, medication, or further testing.

Benefits of DEXA Scans

DEXA scans offer numerous advantages in osteoporosis prevention and encourage early screening, which can significantly impact long-term bone health.

Advantages in Osteoporosis Prevention

DEXA scans provide several key benefits in preventing osteoporosis and its complications. These scans offer precise measurements of bone density, allowing for early detection of bone loss before it progresses to osteoporosis.

By identifying individuals at risk, DEXA scans enable healthcare providers to implement preventive measures early. This may include lifestyle modifications, dietary changes, or medication to slow or prevent further bone loss.

DEXA scans also allow for monitoring of treatment effectiveness over time. Regular scans can track changes in bone density, helping healthcare providers adjust treatment plans as needed for optimal bone health.

Encouraging Early Osteoporosis Screening

Early osteoporosis screening through DEXA scans is crucial for maintaining long-term bone health. These scans can detect low bone mass before a fracture occurs, allowing for proactive intervention.

Encouraging regular DEXA screenings, especially for high-risk individuals, can lead to better outcomes and reduced fracture risk. Early detection and intervention can significantly improve quality of life and reduce healthcare costs associated with osteoporosis-related fractures.

By raising awareness about the importance of DEXA scans, healthcare providers can motivate patients to take an active role in their bone health. This proactive approach can lead to better overall health outcomes and improved patient engagement in preventive care.

DEXA Scan FAQs

• What is a DEXA scan?
• Who should get a DEXA scan?
• Is a DEXA scan painful?
• How often should you have a DEXA scan?

If you are concerned about your bone health, please contact Pure Rheumatology London on 0207 126 7264 and you will be booked in for a comprehensive bone health assessment.

Article by Dr. Naveen Bhadauria

Most people will experience back pain at some point in their lives, with a number of different causes to blame, including:

• Ankylosing spondylitis – a long-term chronic condition that affects the spine and other areas of the body
• Herniated disc – also known as a slipped or prolapsed disc, this is when the tissues that cushion the bones in your spine bulge outwards
• Sciatica – this is when the sciatic nerve, which runs from your lower back to your feet, becomes compressed (trapped) or irritated
• Other serious, but rare, conditions, such as an infection or cancer

But the most common type of back pain is “non-specific lower back pain”. This is where the cause of the back pain cannot be identified. This type of back pain can be acute (lasting less than three months) or chronic (lasting three months or more), and the severity of the pain can vary from person to person.

There are a variety of environmental and individual risk factors for non-specific lower back pain, including obesity, lack of exercise, heavy lifting, smoking, stress and depression. However, as Consultant Rheumatologist Dr. Naveen Bhadauria explains, “in many cases, it is possible to prevent back pain, even if some of these risk factors apply to you. By making small, positive changes to your lifestyle, such as improving your diet and undertaking regular exercise, you can decrease the risk of back pain and even improve your bone and joint health along the way.”

Why Is Lower Back Pain So Common?

Lower back pain is common for a number of reasons. At the core of those is the human anatomy. Having evolved to walk on two legs, the bones in our spines are stacked on top of each other. Though these bones are supported by muscles and ligaments, factors such as weight gain and muscle weakness can increase the risk of herniation or fracture.

Sedentary lifestyles are adversely affecting spinal health. In today’s industrialised world, many workers spend most of their waking hours sitting at a desk; this can mean that the back muscles are not being adequately strengthened, leading to a weaker mid-section and an increased risk of injury. Although this can be mitigated through exercise, a Government report on physical activity in England published in 2024 revealed that 36.9% of the population engaged in less than 150 minutes of moderate intensity exercise per week, with even higher percentages amongst minority ethnic groups, women, and those who are unemployed or working in routine and manual occupations.

These factors, in combination with:

• high rates of obesity (64% of adults in England are estimated to be overweight or obese, and this percentage has increased over the past decade);
• high prevalence of poor mental health (one in six people in England report having a common mental health problem, such as depression or anxiety, according to the charity Mind);
• and an increase in both osteoarthritis (due to an ageing population) and inflammatory arthritis such as rheumatoid arthritis (due to factors such as obesity, stress, smoking and air pollution)

mean that we are likely to see the prevalence of lower back pain remaining the same or increasing if more is not done to educate the population about the associated risk factors and implications of the condition, and encourage individual responsibility when it comes to personal healthcare.

20 Simple Lifestyle Changes To Help Prevent Back Pain

Small adjustments to your daily routine can make a big difference in keeping your spine healthy and pain-free. From improving posture and staying active to choosing the right mattress and managing stress, these simple lifestyle changes can help protect your back in the long run. Here are 20 easy ways to support your spine and reduce the risk of discomfort.

Posture And Ergonomics

• Maintain good posture – Keep your back straight and shoulders relaxed when sitting or standing.
• Use ergonomic furniture – Choose a supportive chair with lumbar support and adjust your desk to the right height.
• Avoid prolonged sitting – Take breaks every 30–60 minutes to stand, stretch or walk around.
• Adjust your screen height – Keep your monitor at eye level to prevent hunching forward.
• Lift properly – Bend your knees and keep your back straight when lifting objects, using your legs for power.

Exercise And Movement

• Strengthen core muscles – A strong core provides better spinal support and stability. Try abdominal exercises such as planks, Russian twists and crunches to strengthen your core.
• Stretch regularly – Incorporate daily stretches for the back, hamstrings and hips to improve flexibility.
• Engage in low-impact exercise – Activities like swimming, walking and yoga can help maintain spinal health.
• Avoid repetitive motions – If your job or hobby requires repeated movements, take breaks and switch positions regularly.
• Use proper footwear – Supportive, well-cushioned shoes help maintain alignment and reduce back strain.

Sleeping Habits

• Sleep on a supportive mattress – A medium-to-firm mattress supports spinal alignment.
• Use the right pillow – A pillow that supports your neck’s natural curve prevents strain.
• Sleep in a back-friendly position – Sleeping on your back or side with a pillow between your knees can help maintain alignment.

Daily Habits And Lifestyle Adjustments

• Maintain a healthy weight – Excess weight, especially around the midsection, strains the spine.
• Stay hydrated – Proper hydration supports spinal discs and overall muscle function.
• Reduce stress – Chronic stress can lead to muscle tension and back pain. Practices like meditation and breathing exercises can help.
• Quit smoking – Smoking reduces blood flow to the spine and increases the risk of disc degeneration. Try looking for methods to quit smoking naturally, or explore alternatives such as nicotine patches.
• Carry bags correctly – Use a backpack with both straps or opt for a crossbody bag to distribute weight evenly.
• Warm up before exercise – Preparing your muscles before workouts prevents injuries.
• Listen to your body – Avoid overexertion and rest if you experience discomfort to prevent worsening pain

What To Do If You Have Back Pain

If you’re experiencing back pain, it’s important to address it early to prevent it from worsening. If the pain is manageable and not severe, start by avoiding activities that strain your back, applying heat or ice for relief, and incorporating gentle stretches to ease tension, if comfortable. Most back pain will go away on its own within a few days to a few weeks.

However, if the pain persists, worsens or affects your daily activities, it may be a sign of an underlying condition that requires medical attention. A rheumatologist can assess your symptoms, aim to identify the root cause, and recommend the best treatment plan.

Book a consultation with Dr. Naveen Bhadauria to get expert advice and take the first step towards lasting relief. Call 020 7126 7264 or visit his contact page.

Article by Dr. Naveen Bhadauria

Over three million people in the UK are living with osteoporosis – that’s in excess of 4.5% of the population, making it the most common bone disease. It is also linked to injury-related deaths in people over the age of 75, with fractures (caused by falls) leading to immobility, deep vein thrombosis, mental health decline, infections and other complications.

In acknowledgement of Osteoporosis Awareness and Prevention Month, we want to emphasise the importance of education when it comes to bone health, and the steps that can be taken to reduce the risk of osteoporosis.

Dr Naveen Bhadauria, Consultant Rheumatologist at Pure Rheumatology London, explains, “Age-related osteoporosis is common, but it doesn’t have to be a fact of life. In fact, you can maintain strong bones and joints well into old age with simple, yet key, lifestyle changes. If you can implement these changes earlier in life, this will contribute significantly towards better bone health in your later years. However, it is never too late to start making healthy decisions to reduce your risk of osteoporosis and fractures.”

What Is Osteoporosis?

Osteoporosis is a condition that causes bones to weaken, making them more prone to fractures. It develops gradually over time, often without noticeable symptoms until a fracture occurs. The most common fractures due to osteoporosis occur in the hip, wrist and spine. However, the pelvis, arms and other bones may also be affected. In progressed cases, even minor movements like sneezing can cause a fracture.

Bone is a living tissue composed mainly of collagen and calcium phosphate, which provide strength and flexibility. It has three layers:

• Periosteum: A thin membrane that contains nerve and blood vessels
• Compact bone: The dense, outer layer that provides structural support
• Cancellous bone: The spongy inner layer that contains bone marrow

Osteoporosis occurs when the balance between bone formation and bone resorption is disrupted. Osteoblasts (bone-forming cells) and osteoclasts (bone-resorbing cells) play an important role in maintaining bone health. Factors such as age, genetics, hormone levels, physical activity and nutrition influence this balance.

Menopausal women are amongst those at high risk of developing osteoporosis, with one in three women affected by the disease, in comparison with one in five men. This is because, post-menopause, women’s bodies start producing less oestrogen, which is an important hormone for strengthening bones.

Diagnosing And Treating Osteoporosis

How Osteoporosis Is Diagnosed

Osteoporosis is often diagnosed after a fracture, but proactive screening can help detect bone loss earlier.

A DEXA (dual-energy X-ray absorptiometry) scan is the gold standard for measuring bone density. This quick, painless test compares the patient’s bone density against that of a healthy adult of the same age and sex, providing a score that indicates bone health.

Treatment For Osteoporosis

Treatment options depend on factors such as age, sex, fracture risk and bone density results. Common treatments include:

• Bisphosphonates: Medications that slow bone resorption and are taken as tablets or injections
• Calcium and vitamin D supplements: Essential for bone health and often recommended for those with osteoporosis
• Hormone therapy: Oestrogen therapy for postmenopausal women and testosterone therapy for men with low levels
• Zoledronate (Zoledronic acid) IV treatment: A well-researched, effective alternative for managing osteoporosis with long-lasting benefits
• Romosuzumab: This is one of the latest treatments for osteoporosis and is an injectible medication.

At Pure Rheumatology London, we offer zoledronate IV treatment with consultations available at multiple London locations.

Osteopenia: A Precursor To Osteoporosis

Osteopenia refers to lower-than-average bone density, but not low enough to be classified as osteoporosis. While it does not always require treatment, those with osteopenia should take steps to protect their bones by engaging in regular weight-bearing exercise; maintaining a balanced diet with a focus on increasing intake of calcium and vitamin D; avoiding smoking and excessive alcohol consumption; and monitoring bone density over time with regular check-ups by a rheumatologist.

Don’t be worried if you have received a diagnosis of osteopenia. The condition does not always lead to osteoporosis, and your rheumatologist can advise you on the next steps.

Daily Habits To Help Reduce The Risk Of Osteoporosis

Adopting bone-strengthening habits early can significantly reduce the risk of osteoporosis. Prevention strategies include:

Maintaining A Regular Exercise Routine

Weight-bearing exercises help build and maintain bone density, as well as strengthen the muscles around your bones, helping to build an overall stronger frame. These include activities such as:

• Walking, aiming for at least 30 minutes most days of the week
• Strength training, such as lifting weights, using resistance bands or using your bodyweight (calisthenics) to strengthen bones and muscles
• Yoga and pilates, which help with balance and coordination, reducing the risk of falls and other injuries

Eating A Calcium Rich Diet

Calcium is essential for strong bones. Try to ensure that your diet includes:

• Dairy products such as milk, cheese and plain yoghurt
• Leafy green vegetables like kale, broccoli and bok choy
• Tinned salmon and sardines (with bones)
• Fortified foods such as certain cereals, plant-based milk and orange juice with added calcium

For adults, the recommended daily intake is 700mg of calcium. Women over 50 and men over 70 should aim for 1200mg per day.

Getting Enough Vitamin D

Vitamin D helps the body absorb calcium. You can maintain healthy levels by:

• Getting safe sun exposure: Aim for 10 to 30 minutes of morning sunlight on your skin a few times per week. Avoid prolonged afternoon sun exposure without SPF, as excessive UV exposure can damage your skin.
• Eating vitamin D-rich foods: These include oily fish (such as salmon and mackerel), egg yolks and fortified dairy products.
• Taking a vitamin D supplement if you are at risk of deficiency (speak to your doctor about dosage).

Avoiding Smoking

Smoking negatively affects bone health by reducing bone mass and slowing the production of bone-forming cells. If you smoke, consider seeking support from a healthcare professional to quit; using nicotine replacement therapy or prescription medications if needed; or joining a smoking cessation support group.

Limiting Alcohol Intake

Excessive alcohol consumption can weaken bones and increase the risk of fractures. To maintain bone health:

• Stick to recommended limits; no more than 14 units spread over a week
• Choose lower-alcohol options or alcohol-free days
• Stay hydrated and pair alcohol with food to reduce its effect on the body

Improving general wellbeing

Factors such as stress and poor sleep can play havoc on your mind and body, which can make improving your bone health more challenging. Keeping your general mental and physical health in check is important for managing your bone health holistically. Try stress reducing activities such as meditation and breath work, and focus on getting good quality sleep by following a good sleep hygiene routine each night.

Osteoporosis: When To Speak To A Healthcare Professional

As you get older, it’s important to discuss bone health with your doctor, especially if you have risk factors for osteoporosis. Your doctor may recommend a bone density (DEXA) scan to assess your bone health; suggest lifestyle changes or medications to prevent bone loss; and test your vitamin D and calcium levels.

If you are concerned about your bone health or at risk of osteoporosis, book a consultation with Dr. Naveen Bhadauria at Pure Rheumatology London for expert advice, diagnosis and treatment options. To book your appointment, use the online booking form or call 0207 126 7264.

Article by Dr. Naveen Bhadauria