title: Methotrexate in chronic-recurrent calcium pyrophosphate deposition disease: no significant effect in a randomized crossover trial.
abstract: BACKGROUND
  Calcium pyrophosphate deposition (CPPD) may cause severe arthropathy, major joint destruction and treatment options are limited. The aim of this study was to test the therapeutic efficacy of methotrexate (MTX) in chronic or recurrent CPPD arthropathy.
  
  
  METHODS
  Patients with CPPD arthropathy were randomized to receive either weekly subcutaneous injections of 15 mg/week of MTX or placebo (PBO) for three months, in a double-blind, crossover randomized controlled trial. Inclusion criteria comprised definite CPPD disease, recurrent arthritis or persistent polyarthritis, and an insufficient response to NSAIDs, glucocorticoids or colchicine. The primary outcome was an improvement in the disease activity scores based on 44 joints (DAS44). The analysis was performed on an intent-to-treat basis.
  
  
  RESULTS
  We randomized 26 patients, and compared 25 treatment periods on MTX with 21 treatment periods on PBO. Baseline characteristics were balanced between the groups. The evolution of the DAS44 was not statistically significantly different between groups (median DAS44 decreased by -0.08 on MTX versus -0.13 on PBO, after three months, P = 0.44). Furthermore, pain levels remained stable in both groups (median change in VAS Pain -1 unit on MTX and 0 on PBO, P = 0.43), and none of the secondary outcomes was significantly different between the two groups. Minor adverse events (AE) did not differ in frequency between the groups, but the only serious AE occurred on MTX (bicytopenia).
  
  
  CONCLUSIONS
  The results of this trial with MTX in this older population with chronic or recurrent CPPD arthropathy suggest no strong effect of MTX on disease activity.
  
  
  BACKGROUND
  EudraCT No: 2007-003479-37. Registered 26 April 2008.
authors.forename: Axel
authors.initials: A
authors.lastname: Finckh
authors.forename: Geraldine M
authors.initials: GM
authors.lastname: Mc Carthy
authors.forename: Anne
authors.initials: A
authors.lastname: Madigan
authors.forename: Daniel
authors.initials: D
authors.lastname: Van Linthoudt
authors.forename: Marcel
authors.initials: M
authors.lastname: Weber
authors.forename: David
authors.initials: D
authors.lastname: Neto
authors.forename: Georges
authors.initials: G
authors.lastname: Rappoport
authors.forename: Sandra
authors.initials: S
authors.lastname: Blumhardt
authors.forename: Diego
authors.initials: D
authors.lastname: Kyburz
authors.forename: Pierre-Andre
authors.initials: PA
authors.lastname: Guerne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use; D002805:Chondrocalcinosis / Q000188:drug therapy* / Q000473:pathology; D002908:Chronic Disease; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate