Q. A 45-year-old woman is admitted with complaints of joint pain, stiffness, and swelling in her hands, wrists, and feet. She reports that the symptoms have been present for several months, and have progressively worsened over time. She has also been experiencing fatigue, malaise, and loss of appetite. She denies any history of trauma or recent infections. On physical examination, the patient has tender and swollen joints in her hands, wrists, and feet. Her range of motion is limited, and she has difficulty performing simple tasks, such as holding a pen or buttoning her shirt. Laboratory investigations reveal elevated levels of C-reactive protein and rheumatoid factor. Imaging studies show erosive changes and joint space narrowing, consistent with rheumatoid arthritis. She is started on nonsteroidal anti-inflammatory drugs and corticosteroids for symptom relief. You decided she will require long-term disease-modifying antirheumatic drugs to manage her condition. You have a discussion with the patient about the potential benefits and risks of different disease-modifying antirheumatic drugs. Specifically, you decide to start her on methotrexate, which you explain is a first-line therapy for rheumatoid arthritis. Which of the following statements regarding methotrexate do you counsel the patient is NOT true?