“…Third, other classes of DMARDs (conventional, targeted, and biologic) have less efficacy when used as monotherapy than when combined with methotrexate [10]. Fourth, in addition to having good efficacy and good safety profile, economically, the price is also relatively cheaper than other therapeutic modalities [11], [12]. Methotrexate is recommended as a first-choice drug by various international and national organizations such as the European League Against Rheumatism (EULAR), American College of Rheumatology (ACR), Asia Pacific League Against Rheumatism (APLAR) and Indonesia Rheumatology Association (IRA) [13]- [16].…”