Hi! Gigsie.
As this is not my area of expertise, i would imagine that you know more about R.A than i do, so please take this into consideration when you read my post.
The object of treatment is to try and halt or maybe reverse the X-Ray appearances of the disease and more importantly to relive pain.
I will not go into the drugs that will achieve this, as i am sure that you are well versed in this issue.
Methotrexate, certainly is not the first drug of choice in the initial phase, but most studies have shown that with or without NSAIDs it plays a valuable part in slowing daown the disease and of relieving pain. I would go as far as saying that it is the drug of choice when pain is resistant to other forms of treatment.
Yes, there is a downside to Methotrexate,as it may affect the liver and certainly the lungs, but these are extremely rare side effects and balanced against the pain relief, are well worth taking.
If I have missed the point of your query, please let me know.