Long-term prospective study of methotrexate in the treatment of rheumatoid arthritis. 84-month update.
OBJECTIVE
To determine the long-term efficacy and safety of low-dose methotrexate (MTX) in rheumatoid arthritis (RA).


METHODS
Eighty-four-month open prospective trial at a single academic rheumatology center.


RESULTS
Twenty-six patients were enrolled in a prospective study of the long-term efficacy of MTX in RA; a significant improvement had been demonstrated after 36 months of therapy. Twelve patients remained in the study at the 84-month visit; the mean weekly dosage of MTX was 10.2 mg. A significant improvement was still noted at 84 months in the number of painful joints, number of swollen joints, joint pain index, joint swelling index, and physician and patient global assessments. A 50% improvement in the joint pain index and joint swelling index was observed in more than 80% of the 12 patients still enrolled. A significant reduction in prednisone dosage was achieved; of 14 patients taking prednisone at entry, 7 had discontinued prednisone completely. Fourteen patients withdrew from the study: 10 between 0 and 36 months, and 4 between 36 and 84 months. Toxicity in 3 patients and visit noncompliance in 1 patient were the reasons for withdrawal between 36 and 84 months. At 84 months, 46% of the patients remained in the study; 11.5% had discontinued due to MTX toxicity.


CONCLUSIONS
The effectiveness of MTX in the treatment of RA continues to be demonstrated in this prospective study, after 84 months of treatment.
Weinblatt
M E
ME
Department of Rheumatology and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
Weissman
B N
BN
Holdsworth
D E
DE
Fraser
P A
PA
Maier
A L
AL
Falchuk
K R
KR
Coblyn
J S
JS
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D001706:Biopsy; D004334:Drug Administration Schedule; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000139:chemically induced; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D011241:Prednisone / Q000008:administration & dosage; D011446:Prospective Studies; D011658:Pulmonary Fibrosis / Q000209:etiology; D011859:Radiography; D016896:Treatment Outcome
D011241:Prednisone; D008727:Methotrexate