I refused to take Methotrexate when the doctors first wanted me to because of all the side affects. They told me that it was not a question of if... it was a question or when... and how much damage was enough damage. Three years later I started Mtx out of desparation... I wanted some quality of life back. The tablets of Mtx were not having the desired results so my rheumy started me on injections that helped a little more. Yes, I did notice that there was some hair loss at first, however it leveled off. I have blood test every 6-8 weeks to watch my liver and blood counts (sometimes my white count gets a little too low). The only real annoying side affect for me is the nausea and fatigue the following day. But I deal with it because of the trade off. My doctor cocktailed the mtx with arava and I can truly say that the combination to the two drugs has really controlled the disease process instead of just treating the symptoms with narcotic painkillers or daily doses of NSAIDs. My biggest regret---I really wish I would have started the mtx sooner so I could have prevented some of the joint damage.