title: Methotrexate is an option for patients with refractory calcium pyrophosphate crystal arthritis.
abstract: BACKGROUND
  Patients with calcium pyrophosphate deposition disease sometimes require a continuous therapy. Nonsteroidal anti-inflammatory drugs, colchicine, and glucocorticoids are commonly used with good results, but occasionally, these are ineffective, contraindicated, or not tolerated. We present our experience with methotrexate (MTX) in refractory CPP arthritis.
  
  
  METHODS
  An observational study to describe and evaluate the use of MTX in refractory calcium pyrophosphate deposition disease was undertaken. Ten patients were included. Treatment response was evaluated by the physician (excellent, good, medium, poor, or absent response) and the patient as measured on a 10-cm visual analog scale (0 = no effect; 10 = complete resolution of symptoms). Adverse effects were recorded on all patients.
  
  
  RESULTS
  Five patients presented a persistent polyarthritis, 3 presented a persistent oligoarthritis, and 2 presented a very frequently recurring monoarthritis. Median MTX evaluation by patients on visual analog scale was 7.4, and physicians considered excellent (n = 2), good (n = 5), or medium (n = 3). The safety profile was generally good, but MTX was discontinued in 2 patients because of adverse effects (transient bone marrow aplasia and elevation of liver enzymes).
  
  
  CONCLUSIONS
  Methotrexate could be an effective and safe option for patients with refractory CPP arthritis, but additional studies are necessary to determine to what extent and for which patients MTX is effective.
authors: Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain. drmarianoandres@gmail.com
authors: Mariano
authors: M
authors: Andres
authors: Francisca
authors: F
authors: Sivera
authors: Eliseo
authors: E
authors: Pascual
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002805:Chondrocalcinosis / Q000188:drug therapy*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate