Background Rheumatoid arthritis and seronegative spondyloarthropathies have high prevalence and present as the major cause of early invalidity worldwide. DMARDs present as an essential part of the treatment of these diseases. Methotrexate (MTX) is a fast working and effective DMARD. It has proved to have the best efficacy-toxicity ratio. Nevertheless, up to 30% of patients discontinue MTX intake both because of inefficacy and toxicity.
Objectives The main objective of the study is the determination of factors associated with MTX efficacy in patients with different arthritides.
Methods 90 patients (65 female, 25 male, mean age 48,49±15,12 years, 79 with rheumatoid arthritis, 7 with ankylosing spondylitis, 4 with psoriatic arthritis) were investigated. The anamnestic and treatment data were obtained. Joint disease activity scores (DAS, BASDAI), indices of joint disability (HAQ-FI, BASFI) and presence of extra-articular manifestations were determined. The CBC, urinalysis, determination of serum concentrations of homocysteine, creatinine, bilirubin, transaminases, glucose, CRP and RF, X-ray examination of hands/feet were performed. Both univariate and multivariate analyses (logistic regression) were performed to determine the factors associated with MTX efficacy.
Results Only 60 from observed 90 patients were taking MTX regularly. The mean duration of MTX treatment was 107.7±11.6 weeks, mean cumulative MTX dose was 996.1±110.4 mg. The complete remission on MTX treatment was observed in 12 patients (20% of patients on regular MTX treatment). According to the results of univariate analysis and multivariate logistic regression, MTX efficacy was significantly (p<0,05) associated with absence of intraarticular corticosteroids in treatment scheme (OR (95% CI) = 5,6 (1,4-22,3), p<0,05) and low functional articular indices HAQ-FI and BASFI (OR (95% CI) = 36,7 (4,4-303,6), p<0,01).
Conclusions The possible association of more than 20 routine clinical and laboratory factors with MTX efficacy is studied. We’ve found that positive response to MTX treatment is associated with peculiarities of concomitant treatment with corticosteroids and less degree of joint disability. No other clinical or laboratory factor was found predictive for positive response to MTX. Further studies are needed to investigate novel biological or other markers.
Hider S.L., Silman A.J., Thomson W. et al Can clinical factors at presentation be used to predict outcome of treatment with methotrexate in patients with early inflammatory polyarthritis? Ann Rheum Dis 2008;68:57–62.
Disclosure of Interest None Declared