Positives

• A post-COVID patient with new inflammatory arthritis reported that methotrexate slowed flare-ups and reduced new joint bumps once their rheumatologist added it to their regimen Mayo Clinic Connect.
  
  
• Patients on methotrexate during COVID infection showed milder disease courses, possibly due to inhibited TNF-alpha and increased regulatory T cells PMC.
  
  

Negatives

• Some patients could not tolerate methotrexate at all and had to switch to biologic infusions to manage their post-COVID inflammation Mayo Clinic Connect.
  
  
• Patients on methotrexate showed blunted vaccine response, leaving them more vulnerable to reinfection unless they paused the drug for two weeks around each shot Arthritis Foundation.
  
  

Hurdles & Side Effects

• Patients typically wait 6 to 8 weeks before noticing symptom improvement, and many described the disease and waiting period as "horrible and very depressing" Mayo Clinic Connect.
  
  
• Patients require regular liver and blood-count labs and must avoid alcohol, which complicates daily life for many post-COVID adults Mayo Clinic.