title: A randomized placebo-controlled trial of methotrexate in psoriatic arthritis.
abstract: OBJECTIVE
  MTX is widely used to treat synovitis in PsA without supporting trial evidence. The aim of our study was to test the value of MTX in the first large randomized placebo-controlled trial (RCT) in PsA.
  
  
  METHODS
  A 6-month double-blind RCT compared MTX (15 mg/week) with placebo in active PsA. The primary outcome was PsA response criteria (PsARC). Other outcomes included ACR20, DAS-28 and their individual components. Missing data were imputed using multiple imputation methods. Treatments were compared using logistic regression analysis (adjusted for age, sex, disease duration and, where appropriate, individual baseline scores).
  
  
  RESULTS
  Four hundred and sixty-two patients were screened and 221 recruited. One hundred and nine patients received MTX and 112 received placebo. Forty-four patients were lost to follow-up (21 MTX, 23 placebo). Twenty-six patients discontinued treatment (14 MTX, 12 placebo). Comparing MTX with placebo in all randomized patients at 6 months showed no significant effect on PsARC [odds ratio (OR) 1.77, 95% CI 0.97, 3.23], ACR20 (OR 2.00, 95% CI 0.65, 6.22) or DAS-28 (OR 1.70, 95% CI 0.90, 3.17). There were also no significant treatment effects on tender and swollen joint counts, ESR, CRP, HAQ and pain. The only benefits of MTX were reductions in patient and assessor global scores and skin scores at 6 months (P = 0.03, P < 0.001 and P = 0.02, respectively). There were no unexpected adverse events.
  
  
  CONCLUSIONS
  This trial of active PsA found no evidence for MTX improving synovitis and consequently raises questions about its classification as a disease-modifying drug in PsA. Trial registration. Current Controlled Trials, www.controlled-trials.com, ISRCTN:54376151.
authors.affiliation: Department of Rheumatology, King's College London School of Medicine, King's College London, London SE5 9RJ, UK. gabrielle.kingsley@kcl.ac.uk
authors.forename: Gabrielle H
authors.initials: GH
authors.lastname: Kingsley
authors.forename: Anna
authors.initials: A
authors.lastname: Kowalczyk
authors.forename: Helen
authors.initials: H
authors.lastname: Taylor
authors.forename: Fowzia
authors.initials: F
authors.lastname: Ibrahim
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Packham
authors.forename: Neil J
authors.initials: NJ
authors.lastname: McHugh
authors.forename: Diarmuid M
authors.initials: DM
authors.lastname: Mulherin
authors.forename: George D
authors.initials: GD
authors.lastname: Kitas
authors.forename: Kuntal
authors.initials: K
authors.lastname: Chakravarty
authors.forename: Brian D M
authors.initials: BD
authors.lastname: Tom
authors.forename: Aidan G
authors.initials: AG
authors.lastname: O'Keeffe
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Maddison
authors.forename: David L
authors.initials: DL
authors.lastname: Scott
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015535:Arthritis, Psoriatic / Q000188:drug therapy* / Q000503:physiopathology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D012720:Severity of Illness Index; D013585:Synovitis / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate