[Long-term survival of methotrexate in psoriatic arthritis].
OBJECTIVE
The purpose of this study was to evaluate the long-term survival rate of Methotrexate (MTX) in the peripheral joint involvement of psoriatic arthritis (PsA) in a setting of everyday clinical practice.


METHODS
This was an observational restrospective study performed using the data from a dermatological-rheumatological PsA clinic. All of the patients evaluated at this clinic from March 1997 to December 2007 who were started on MTX alone, had a three-year follow-up time or had discontinued the therapy were included into the survey.


RESULTS
Of the 174 evaluable patients, 104 (59.8%) were still taking MTX after three years of treatment. The reasons of therapy discontinuation in the remaining 70 (40.2%) patients were: 34 (19.5%) lost-to-follow-up, 18 (10.3%) adverse events, 14 (8%) inefficacies, and 4 (2.3%) deaths (none related to the therapy). MTX was effective in controlling joint inflammation but not in preventing their deterioration. Overall, adverse events were recorded in 43 patients (36.4% of the 114 patients with a three-year follow-up). No serious side effect occurred in the study population.


CONCLUSIONS
The results of this study showed that, in a setting of clinical pratice, MTX had a good three-year performance in patients with peripheral PsA. Almost 60% of them were still taking this drug at the end of the study period and the toxicity was more than acceptable. In our opinion, MTX might be considered the non-biological DMARD of choice for the treatment of this condition. However it should be used earlier and at higher doses.
Ricci
M
M
U.O.C. Day Hospital di Reumatologia, Istituto Ortopedico Gaetano Pini, Milano, Italia. massiminor@alice.it
De Marco
G
G
Desiati
F
F
Mazzocchi
D
D
Rotunno
L
L
Battafarano
N
N
Marchesoni
A
A
D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D008727:Methotrexate