Low dose once weekly methotrexate is the gold standard treatment for Rheumatoid Arthritis and other immune related diseases. It is usually give once a week as a tablet. However sometimes patients struggle to tolerate it or it is not effective. Giving the medication via a subcutaneous injection can be more effective and or have less side effects. Australia does not have PBS listed pre filled syringes of MTX so many patients give up on this medication and move to alternatives that are more costly.