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Keywords : Methotrexate, oral ulceration, mucositis, DMARD, pancytopenia, rheumatoid arthritis Abbreviations MTX: methotrexate MIOM: methotrexate-induced oral mucositis DMARDs: disease-modifying anti-rheumatic drugs RA: rheumatoid arthritis LDMTX: low-dose methotrexate ADR: adverse drug reaction UPOHC: University of Pretoria Oral Health Centre FBC: full blood count RCC: red cell count Hb: haemoglobin MCV: mean corpuscular volume MCH: mean corpuscular haemoglobin MCHC: mean corpuscular haemoglobin concentration GERD: gastroesophageal reflux disease eGFR: estimated glomerular filtration rate DHFR: dihydrofolate reductase DHF: dihydrofolate THF: tetrahydrofolate TS: thymidylate synthase AICART: aminoimidazole carboxamide ribonucleotide transformylase RFC1: reduced folate carrier 1 MTX-PG: methotrexate-polyglutamate PPI: proton pump inhibitor INTRODUCTION Methotrexate (MTX) was originally developed to treat malignant diseases