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Long-term experience with low dose methotrexate in rheumatoid arthritis

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Summary

One hundred twenty-six patients with rheumatoid arthritis (RA) were treated with weekly low doses of methotrexate (MTX) for a mean period of 36.8 months (range 13–110 months). The overall probability of continuing with MTX therapy was 72% at 2 and 3 years, 67% at 4 years and 65% at 5–7 years. Seronegative patients had a higher probability of continuing therapy than seropositive patients (P<0.05). Out of the whole group, 8% showed no improvement, 16% showed mild improvement, and 30% showed moderate improvement, and 45% experienced marked improvement. Eight patients (6%) of the latter group achieved complete clinical remission. In the course of the follow-up period there was a significant decrease in the mean daily dosage of prednisone and NSAIDs. Minor side effects were common (68%), but therapy was discontinued in only 27 patients (21%) because of major complications. In most of them (25 out of 27) these occured within the first 24 months of therapy. Although malignancy was revealed in 5 patients during the follow-up period, its occurrence did not differ from expected rates.

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References

  1. Tishler M (1990) Efficacy and toxicity of methotrexate in RA. In: Yaron M (ed) Methotrexate for rheumatoid, arthritis. Tel Aviv, pp 31–58

  2. Weinblatt ME, Weissman BN, Holdsworth DE, Fraser PA, Maier AL, Falchuk KR, Coblyn JSI (1992) Long-term prospective study of methotrexate in the treatment of rheumatoid arthritis 84-month update. Arthritis Rheum 35:129–137

    Google Scholar 

  3. Kremer JM, Phelps CT (1992) Long term prospective study of the use of methotrexate in the treatment of rheumatoid arthritis-update after a mean of 90 months. Arthritis Rheum 35:138–145

    Google Scholar 

  4. Tishler M, Caspi D, Rosenbach TO, Fishel B, Wigler I, Segal R, Gazit E, Yaron M (1988) Methotrexate in rheumatoid arthritis: a prospective study in Israeli patients with immunogenetic correlations. Ann Rheum Dis 47:654–659

    Google Scholar 

  5. Roper MW, Bennett GA, Cobb S, Jacox R, Jessar RA (1958) 1958 revision of the diagnostic criteria for rheumatoid arthritis. Bull Rheum Dis 9:175–176

    Google Scholar 

  6. Pinals RS, Masi AT, Ransen RA (1981) Preliminary criteria for clinical remission in rheumatoid arthritis. Arthritis Rheum 24:1308–1315

    Google Scholar 

  7. Merrell M, Shulman LE (1955) Determination of prognosis in chronic disease illustrated by systemic lupus erythematosus. J Chronic Dis 1:12–32

    Google Scholar 

  8. Greenwood M (1932) Epidemiology, historical and experimental. The Johns Hopkins Press, Baltimore

    Google Scholar 

  9. Segal R, Caspi D, Tishler M, Fishel B, Yaron M (1988) Accelerated nodulosis and vasculitis during methotrexate therapy for rheumatoid arthritis. Arthritis Rheum 31:1182–1185

    Google Scholar 

  10. Tishler M, Caspi D, Halperin Z, Baratz M, Moshkowitz M, Yaron M (1992) A prospective analysis of liver biopsies in RA patients receiving long term methotrexate therapy. Rheumatol Int 12:39–41

    Google Scholar 

  11. Szanto E (1989) Low dose methotrexate treatment of rheumatoid arthritits: long term observations. Clin Rheumatol 8:323–330

    Google Scholar 

  12. Kremer JM, Lee JK (1988) A long term prospective study of the use of methotrexate in rheumatoid arthritis. Update after a mean of 53 months. Arthritis Rheum 31:577–584

    Google Scholar 

  13. Alarcon GS, Tracy IC, Blackburn WD (1989) Methotrexate in rheumatoid arthritis. Toxic effects as the major factor in limiting long term treatment. Arthritis Rheum 32:671–676

    Google Scholar 

  14. Situnayake RD, Grindulis RA, McConkey B (1987) Long term treatment of rheumatoid arthritis with sulphasalazine, gold or penicillamine: a comparison using life-table methods. Ann Rheum Dis 46:177–183

    Google Scholar 

  15. McCarty DJ (1988) Clinical picture of rheumatoid arthritis. In: McCarty DJ (ed) Arthritis and allied conditions, 11 ed. Lea & Febiger, Philadelphia, pp 715–742

    Google Scholar 

  16. Katz L, Iscovich J, Stinitz R (1990) Cancer in Israel. Incidence and mortality. Department of Epidemiology, Ministry of Health, State of Israel, Jerusalem

    Google Scholar 

  17. Nyfors A, Jenson J (1983) Frequency of malignant neoplasms in 248 long term methotrexate treated psoriatics. Dermatologica 107:260–261

    Google Scholar 

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Tishler, M., Caspi, D. & Yaron, M. Long-term experience with low dose methotrexate in rheumatoid arthritis. Rheumatol Int 13, 103–106 (1993). https://doi.org/10.1007/BF00290296

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