title: Effect of peroxisome proliferator-activated receptor gamma agonist (pioglitazone) and methotrexate on disease activity in rheumatoid arthritis (experimental and clinical study).
abstract: OBJECTIVE
  To investigate the combined effect of both pioglitazone and methotrexate on disease activity of rheumatoid arthritis in a biphasic study; experimental and clinical.
  
  
  METHODS
  EXPERIMENTALLY: 50 rats were divided into 5 equal groups; controls, experimental arthritis, methorexate treated (0.1 mg/Kg daily), pioglitazone-treated (10 mg/kg daily), and methotrexate and pioglitazone treated. Clinically: forty-nine diabetic rheumatoid arthritis patients were included. Patients group consisted of 28 patients and they received pioglitazone 30 mg orally beside their usual treatment. Control group consisted of 21 patients and they continued their usual treatment plus placebo. Disease activity was assessed using DAS28 score. Patients were followed up for 3 months.
  
  
  RESULTS
  Pioglitazone produced a significant improvement of serum oxidative stress parameters (P < 0.05), and inflammatory cytokines in the treated arthritic group (P < 0.05). Clinically, the pioglitazone treated group showed significant improvement in DAS28 (P = 0.001) and C-reactive protein (P < 0.0001) compared to placebo group.
  
  
  CONCLUSIONS
  The concomitant use of the PPAR γ agonist pioglitazone and methotrexate appears to be promising therapeutic strategy for rheumatoid arthritis patients.
authors.affiliation: Department of Internal Medicine, Rheumatology and Immunology, Mansoura Faculty of Medicine, Mansoura, Egypt.
authors.forename: Dina
authors.initials: D
authors.lastname: Shahin
authors.forename: Ehab El
authors.initials: EE
authors.lastname: Toraby
authors.forename: Hala
authors.initials: H
authors.lastname: Abdel-Malek
authors.forename: Vivian
authors.initials: V
authors.lastname: Boshra
authors.forename: Ayman Z
authors.initials: AZ
authors.lastname: Elsamanoudy
authors.forename: Dalia
authors.initials: D
authors.lastname: Shaheen