To begin with, methotrexate (MTX) has rather low toxicity when taken as indicated, without the use of alcohol, and without concominatnt underlying diseases such as hepatitis C, for example. I would say that over-the-counter ibuprofen when taken without medical supervision can be a lot riskier than taking MTX under medical supervision. All the DMARDS used in rheumatology carry some side effects, the safest being Plaquenil (hydroxychloroquire), which requires only annual retinal examinations. The new phosphodiesterase inhibitor, apremilast, just approved for psoriatic arthritis (PsA) has quite low a toxicity profile as well.