Background Methotrexate is commonly used in patients with calcium pyrophosphate deposition (CPPD) condition, although data on methotrexate use for chronic arthritis in CPPD pts are controversial , and it's not clear yet, whether methotrexate can be used as an alternative to colchicine in this group of pts.
Objectives The comparison of efficacy of methotrexate and colchicine in CPPD pts with chronic arthritis, in whom colchicine monotherapy was not sufficient
Methods Results of controlled prospective crossover observational study, including 10 pts (8 females and 2 males) with chronic arthritis associated with CPPD are presented. The inclusion criteria were: age >18 y., the diagnosis of CPPD (by Ryan/McCarty criteria), chronic arthritis and low efficacy of NSAIDs. All patients were initially prescribed colchicine 1 mg/day for 3 months with a 1 month “wash-out” period before prescription of methotrexate s/c 20 mg/week for another 3 months. Pts' mean age was 62.5±11.5 y. Average disease duration was 12.4±12.0 y. For evaluation and monitoring was used to measure disease activity scores based on 44 joints (DAS44), together with the count of swollen and tender joints, pain intensity by VAS, health assessment by HAQ, and serum hsCRP at baseline, after first 3 mo of treatment, after 1 mo of “wash-out” period and after the second 3 mo treatment period. Statistica 10.0 package and Biostatistics were used for statistical processing of data. P values <0.05 were considered statistically significant.
Results At baseline average DAS44 score was 2.47±0.27, swollen joints – 2.0±0.6, tender joints – 2.4±1.1, pain by VAS – 55.2±12.3 mm, serum level of hsCRP – 3.89±3.82 mg/L, HAQ score – 1.1±0.3. After 3 mo of colchicine therapy average DAS44 score was 1.76±0.28 (p=0.004), swollen joints– 1.4±0.5 (p=0.048), tender joints – 1.6±1.35 (p=0.023), pain by VAS – 42.0±13.2 mm (p=0.023), serum level of hsCRP – 3.13±2.85 mg/L (p=0.75), HAQ score – 0.95±0.3 (p=0.041). After 3 mo of colchicines monotherapy good results were documented in 7 pts (4 pts did not have arthritis, 3 patients showed significant reduction in disease activity (by DAS44) and intensity of pain. Insufficient efficacy was obvious in 3 pts. After 1 mo “wash-out” phase DAS44 score was 2.08±0.26, swollen joints – 1.6±0.5, tender joints – 1.7±1.4, pain by VAS – 46.5±9.8 mm, level of hsCRP – 3.38±1.74 mg/L, HAQ score – 1.3±0.34. After 3 mo of methotrexate therapy DAS44 score was 1.39±0.45 (p=0.027), swollen joints – 0.7±0.5 (p=0.023), tender joints – 0.6±0.5 (p=0.007), pain by VAS – 26.0±18.97 mm (p=0.045), serum level of hsCRP – 2.87±2.06 mg/L (p=0.75), HAQ score – 0.8±0,6 (p=0.045). In 2 out of 3 pts with insufficient colchicine efficacy the arthritis was resolved by methotrexate therapy. Meanwhile 2 pts with favorable outcome after colchicine therapy developed exacerbation after methotrexate phase.
Conclusions Colchicine 1 mg/day and methotrexate 20mg/week demonstrate comparable efficacy. Methotrexate 20mg/week should be viewed as first-line choice in chronic arthritis pts associated with CPPD when colchicines efficacy is insufficient
Finckh A, Mc Carthy GM, Madigan A. et al. Methotrexate in chronic-recurrent calcium pyrophosphate deposition disease: no significant effect in a randomized crossover trial. Arthritis Res Ther. 2014 Oct 15;16:458
Disclosure of Interest None declared