Long-Term Prospective Study of the Use of Methotrexate in the Treatment of Rheumatoid Arthritis

Authors

  • Joel M. Kremer MD,

    Professor, Corresponding author
    1. Department of Medicine, Division of Rheumatology, Albany Medical College, and the Albany Medical Center Hospital, Albany, New York.
    • Address reprint requests to Joel M. Kremer, MD, Division of Rheumatology, Albany Medical College, Albany, NY 12208
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  • Carlton T. Phelps MD

    Assistant Professor
    1. Department of Medicine, Division of Rheumatology, Albany Medical College, and the Albany Medical Center Hospital, Albany, New York.
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Abstract

Objective. To determine and describe the clinical, radiographic, and toxicity profile in a cohort of rheumatoid arthritis patients receiving weekly oral methotrexate (MTX) over a mean period of 90 months, and to compare and contrast these data with our previous data on this cohort, reported after 53 months.

Methods. Prospective, open observational study over a mean treatment period of 90 months (range 79—107 months). Standard clinical and laboratory measures of disease activity were assessed by the same investigator at baseline, 1 month, 3 months, and every 3 months thereafter.

Results. A significant improvement from baseline was maintained in all clinical parameters but the number of tender joints. Toxic reactions were as common in months 54—90 as during the first 53 months. The mean dosage of MTX decreased from 14.6 mg/week at the time of the last report to 11.7 mg/week, while the mean prednisone dosage increased from 1.9 mg/day to 2.1 mg/day. Radiographic scores for erosive disease became statistically significantly different from baseline at year 8, and scores for joint space narrowing differed significantly from baseline at years 5 and 8. Since study entry, 2 patients (6.9%) have experienced MTX pneumonitis.

Conclusion. We conclude that a majority of rheumatoid arthritis patients are able to continue MTX treatment with generally sustained efficacy, for intervals that meaningfully exceed those reported previously.

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