My doctor based my diagnosis off a 168 CCP level, X-rays and physical appearances of joints. My X-ray came back that I do not have joint damage yet. I have been having severe pain in my toes and hands, as well as pain in my shoulder and knee. I am just wondering since there is no joint damage as of now, should I consider taking another medication? I am extremely worried about the risks of methotrexate! I eventually want to have children, and this medication has so many warnings of birth defects and pregnancy complications along with risks of cancer and other diseases for myself. Has anyone had extreme complications with this medicine? Did it help?