Background The effects of intra_articular methotrexate (I/A MTX)in knee synovitis in rheumatoid arthritis have been previously evaluated (1). I/A MTX has not been studied in other joints. Ultrasonography (US) has been little studied in I/A MTX.
Objectives To test the efficacy of I/A MTX in rheumatoid arthritis patients with persistent synovitis resistant to systemic methotrexate and other disease modifying antirheumatic drugs (DMARDS) in medium sized joints (ankle, wrist and elbow).
Methods 10 mg of methotrexate was injected intra_articularly in 42 joints (14 wrists, 12 elbows and 16 ankles) in 36 consecutive RA patients with mono/oligo arthritis resistant to systemic DMARDS including methotrexate and other joints in clinical remission. The injection was every week for 8 weeks. Clinical evaluation includes visual analogue scale (VAS), tenderness and swelling was graded on a semiquantitative scale from 0 to 3. Evaluation was done before the 1st injection (W0), 1 week after the 4th injection (W5), 1 week after the last injection (W8) and 3 months later (W20).
On the same days Power Doppler US was done. Synovial thickness and the intra_articular power Doppler signal was graded on a semiquantitative scale from 0 to 3 during the US examination.
Results There was significant reduction in VAS (mean value± SD) between W0 (9±0.5) and W5 (1±1) p<0.001, between W0 (9±0.5) and W8 (0±1) p<0.001 and between W0 and W20 (2.5±0.5) p<0.01.
Tenderness and swelling reduced significantly between W0 (2±1) and W5 (1±1) p<0.001, between W0 and W8 (0±1) p<0.05 and between W0 and W20 (0±1) p<0.001.
Gray US and power Doppler US showed that synovial thickness and intra_articular power signals was reduced significantly between (W0 & W5) and (W0 & W8).
While there was insignificant increase in synovial thickness between W8 and W20. There was significant increase in Power Doppler signals between W8 and W20 p<0.05.
Safety: Only 2 participants reported multiple oral ulcerations during the study.
Conclusions Repeated I/A MTX resulted in a decrease in degree of synovitis of medium seized joints in RA patients both clinically and by power Doppler US. While the clinical effects and the decrease in synovial thickness by gray US continue after 3 months, power Doppler signals tends to increase after 3 months. To the best of our knowledge this the first study to detect the effect of I/A MTX by power Doppler US in medium seized joints.
Iagnocco A, Cerioni A., Coari G. Ossandon A, Masciangelo R., Valesini G. Intra-articular methotrexate in the treatment of rheumatoid arthritis and psoriatic arthritis: a clinical and sonographic study. Clin Rheumatol. 2006 Mar; 25(2):159-63
Disclosure of Interest None Declared
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