title: Methotrexate: should it still be considered for chronic calcium pyrophosphate crystal disease?
abstract: Chronic calcium pyrophosphate crystal arthritis is a clinical consequence of the formation and deposition of these crystals in joints and can result in persistent arthritis. Curative treatment would require the removal of crystals from joints and tissues, but to date all agents tested have proven ineffective. Management of the inflammatory manifestations of chronic calcium pyrophosphate disease includes glucocorticoids, non-steroidal anti-inflammatory drugs, or colchicine, and responses are usually satisfactory. However, in some patients, the response to these agents is poor or they are contraindicated. Methotrexate had been reported as a promising option in small case series; however, in a recent issue of Arthritis Research & Therapy, a clinical trial failed to confirm the anticipated benefits. Here, we discuss some issues that might have influenced the results of the study, before deciding to abandon methotrexate as a therapeutic option for patients with chronic calcium pyrophosphate arthritis.
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Alicante, Pintor Baeza 12, 03010, Alicante, Spain. pascual_eli@gva.es.|Cátedra de Medicina (Reumatología), Universidad Miguel Hernández de Elche, Carretera Nacional 332, s/n. 03550 San Juan de Alicante, Alicante, Spain. pascual_eli@gva.es.
authors.forename: Eliseo
authors.initials: E
authors.lastname: Pascual
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Alicante, Pintor Baeza 12, 03010, Alicante, Spain. drmarianoandres@gmail.com.
authors.forename: Mariano
authors.initials: M
authors.lastname: Andrés
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Elda, Carretera Elda-Sax s/n, 03600, Elda, Spain. fransimas@yahoo.es.
authors.forename: Francisca
authors.initials: F
authors.lastname: Sivera
mesh_terms: D001168:Arthritis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D002131:Calcium Pyrophosphate / Q000009:adverse effects / Q000378:metabolism*; D002805:Chondrocalcinosis / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D002131:Calcium Pyrophosphate; D008727:Methotrexate