Methotrexate is a DMARD (disease modifying anti-rheumatic drug) which
is used to halt the progress of arthritic diseases.  It didn't work
for me (it didn't halt progress, and I had to stop taking it: I was
about 45 y.o. at the time), but I understand it is good for some
people.

I believe it is capable of damaging the liver, so when taking it a
patient should have regular blood tests for liver function (the reason
I had to stop).  I've never heard of anyone suffering the same
reaction as your brother has -- maybe someone else here?

(Incidentally, English doesn't have the "obvious" word malefits in
common use -- a citation search only showed 2 books I have never read:
I would use the word drawback.)

My wife takes it, 15 mg per week.  She takes it in tablet form and built up
the dosage over a few weeks.  It can produce nausea if the dose is slightly
high - it varies for different patients.

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Methotrexate (MTX) is a slow drug and it takes time before the body
gets used to it. Normally you start with a low dose and build it up
over about 4-5 weeks. It is normal to feel a little bit nauseous at
first but you should take some Folic Acid after the weekly dose of MTX
and that should reduce the symptoms. I would tell your brother to keep
trying it and if he still feels bad later then talk to his doctor.

Another way to take MTX is by tablet - normally you take a stronger
dose if you take tablets and this can cause worse side-effects. But it
might be worth trying if he reacts badly to the injections.

I found a low dose of MTX works very well for me (I have Psoriatic
Arthritis) when used in combination with a low dose of Lefleunomide
(Arava). :o)

Hope that helps
Chris R.