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There has been a rise in medication-related osteonecrosis of the jaw (MRONJ) predominantly related to antiresorptive and antiangiogenic medications. More evidence is revealing that MRONJ is not limited to these drug groups. With the introduction of newer and varied medications used in the treatment of cancer and autoimmune diseases, reports of possible related osteonecrosis of the jaw (ONJ) are also on the rise. We present 2 cases of ONJ in patients with long-standing arthritis treated with methotrexate in the absence of a lymphoproliferative disorder and antiresorptive or antiangiogenic medications.