Hi Faye,
I have been on methotrexate for 17 years. [I have a posting down under cytotoxic drugs if you want the whole history] Rarely will you be reduced on your other meds when you add in mtx [abbreviation for methotrexate]. Often you will have folic acid added in as a supplement to help your body neutralize the mtx. Folic acid and mtx are only one chemical bond apart and often the folic acid will be used to stop the damage on healthy cells by mtx.
You ask if it is worth it... For me, yes. It has kept me alive. I can't tolerate higher doses of steroids or plaquenil and this is what has kept my lupus under control.
The reason chemo drugs are used is that they attack rapidly dividing cells. Both inflammatory and cancer cells are rapidly dividing cells. Since it took a while for those cells to build up, it is not going to demolish them in one or two doses. One of the reasons you will get sore and stiff afterwards is that it takes a few days for the body to flush out the "dead" cells. I try to plan on having a couple "down" days after I do my mtx. If I don't need them, fine, but if I do, I have them. After a couple months you may not need them, but it helps to be able to fall back if you do.
Likewise with nausea and diarrhea, I don't always have them, but if I do, I keep compazine and lomotil on hand. It was worse in the early years on the mtx. Now, I rarely have problems, but still keep the back up meds at hand. (I live 7 miles from the nearest pharmacy and that is a LONG way if I needed to get a rx filled for gi problems!)
I found that if I got the burning mouth post mtx, that anything with mint oil would help to slow down the burn. Cool drinks, popsicles, cold things will also slow that down. I do NOT eat hot pepper foods as that is one way to hours long pain from it. Nothing slows down the pain either...has to wear out. Even on 15 mgs a week, I had this effect, and it has stayed with me thru the years. Not everyone gets this, but if it happens, slow down and go to a more basic diet.
Sally