Influence of methotrexate on radiographic progression in rheumatoid arthritis: a sixty-month prospective study.
OBJECTIVE
To evaluate if methotrexate (MTX) can slow disease progression, as determined radiographically, in comparison to other disease modifying drugs in rheumatoid arthritis (RA) patients.


METHODS
Pairs of hand and wrist radiographs from 30 patients treated with MTX and 30 treated with D-penicillamine (DP) were evaluated blindly and separately by two radiologists (A and B) using reference radiographs for scoring. A scale scoring similar to Larsen's standard radiographs with minor modifications was used. The radiographs studied were obtained at the beginning and 5 years after therapy in both groups.


RESULTS
A significantly greater worsening was found in the DP-treated patients (p = 0.025), as compared to MTX patients. Methotrexate showed a slower rate of disease progression than DP. Furthermore, in the MTX group 15 patients remained radiographically stable, 9 worsened and 6 were healed. In contrast, in the DP group 22 patients remained radiographically stable, 8 worsened and none improved.


CONCLUSIONS
The rate of radiographic progression in RA patients was lower in MTX-treated patients compared to those treated with DP. Six patients showed radiological improvement after MTX treatment. Therefore, it seems that MTX could be considered a disease modifying drug.
Drosos
A A
AA
Department of Internal Medicine, University of Ioannina, Greece.
Tsifetaki
N
N
Tsiakou
E K
EK
Timpanidou
M
M
Tsampoulas
C
C
Tatsis
C K
CK
Kotoulas
K
K
Moutsopoulos
H M
HM
D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D010396:Penicillamine / Q000627:therapeutic use; D011446:Prospective Studies; D011859:Radiography; D014953:Wrist / Q000000981:diagnostic imaging
D018501:Antirheumatic Agents; D010396:Penicillamine; D008727:Methotrexate