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Methotrexate vs Mycophenolate

Hi all, would anyone be able to tell me the difference between Mycophenolate and Methotrexate as they seem very similar apart from the Jaundice from Methotrexate.

I'm 21 and was diagnosed at 16, currently on Mycophenolate and have been for 1-2 years now, I don't really have any side effects from it however this year I have been feeling not quite myself health wish. I developed pericarditis in February and have been suffering with foot inflammation this year, plus the normal lupus symptoms... fatigue, rheumatic pains in fingers, knees, neck etc... but worse than it has been in the past.

My Rheumy suggested that I change to Methotrexate but I feel a bit worried about it as it seems stronger and the effects seem a lot worse. I even need to attend a lesson about it before taking it! Anyone had any experience with either / or both medications? It would be much appreciated!



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Hi. I haven't been diagnosed with Lupus yet and I'm 52 so in very different position to you. I was diagnosed with RA over four years ago and put straight onto Methotrexate, which I took for two years. Because of gastric and liver side effects I switched to injectable mtx and this worked well for me along with Hydroxichloraquine. However eventually I became allergic to both drugs. I also had a dramatic allergic reaction to Sulfasalazine five years ago and Azathioprine this year so I'm very unlucky in this regard - have suffered allergic reactions all my life.

But fortunately for me Methotrexate has seen off my RA symptoms to date so it was very effective during the time I took it.

I believe the main difference is that Mycophenolate isn't used at all to treat Rheumatoid Arthritis because it doesn't help with the joints - which are being attacked through synovitis with RA. Myco is used for people with renal disease -primarily as an anti rejection drug for kidney transplants. So it's use for those with connective tissue diseases is a secondary off licence one I think. And I don't think it usually causes as many side effects as Methotrexate can. Methotrexate is more of an all round immunesuppresant and is used primarily, in high doses, as a type of chemotherapy. In lower doses it has been used for decades now as a first line treatment for RA, Lupus, Vasculitis, Scleroderma, Spondyloarthritis and Crohn's Disease so it is a much more commonly used disease modifying antirheumatic drug (DMARD) than Myco.


Hi Ruby, I'm in my 50's and have been on Methotrexate for about four years for possible lupus under the umbrella name of connective tissue disease. Like you I was very wary of taking it but in general it has been OK and has arrested deterioration of the joints in my hands.

I had a bit of nausea and upset bowels to start with but nothing now. I was also given Folic acid to take on the days I didn't take Mtx. In fact the rheumatologist has allowed me to reduce the dose of both as he is pleased with the results.

From my understanding everyone reacts differently but I would give it a good try. Somebody I know took it a couple of times and gave up due to nausea but I sort of worked through that. She is now on high doses of steroids which I am hopeful to avoid. I just have blood tests every three months with my GP now, actually going today! Good luck with whatever you do, I hope you feel some relief from the symptoms soon.


Hi, I'm 19 and was diagnosed when I was 12. I was put in methotrexate for for about two years taking 6 tablets every Sunday. Eventually I had to stop them as I couldn't deal with the nausea although they didn't make me actually sick. However they did improve my symptoms significantly and whilst I was on them it was the most well I've sent (apart from the days I took them) I'm now on azathioprine, prednisone, hydroxychloroquine, omeprazole, and cyclizine and although I feel alright now even on this cocktail of drugs I don't feel as well as I did then. So I would say it is worth a try as you may not get the side effects/you may be able to deal with them. Hope this helps X

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I've been on both. When one stops working I swap to the other. Both are wonder drugs. Methotrexate was a life saver for me. No bad side effects either. Good luck.



Methotrexate is a chemotherapy drug and Mycophenolate alters the DNA of the immune system.

Mycophenolate has a " stronger " immunosupressant effect generally than Methotrexate but different meducations seem to work for different people.

The only thing I would say about Methotrexate ( because you are a young female ) is that pregnancy is totally contraindicated whilst taking it as it's extremely teratogenic.

Have you researched biologic drugs at all such as Rituximab as they can make a huge difference in auto immune disease?


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