title: The rapid kinetics of optimal treatment with subcutaneous methotrexate in early inflammatory arthritis: an observational study.
abstract: Methotrexate (MTX) is standard treatment for RA. Absorption is better in subcutaneous MTX (scMTX), which may impact speed of onset. In RA, earlier time to remission improves long-term results. Our objectives were to determine rapidity of response of subcutaneous methotrexate in early rheumatoid arthritis.
  
  
  
  The change in several disease activity measures (including DAS28) from 0 to 6 weeks (early period) and 6 to 12 weeks (late period) was compared. The proportion achieving DAS28/CDAI/SDAI remission and/or low disease activity state was also compared.
  
  
  
  One hundred three patients were included from a single site between 2008 and 2014. All received MTX (98.0 % scMTX, 98 % 25 mg/week). There were no dropouts. There was a significantly greater early change in DAS28 (-1.9 vs. -0.2, p < 0.00); this effect was seen for several outcome measures. By 6 weeks, 59 % had achieved either DAS28 remission or low disease activity state, with 74 % achieving either state by 12 weeks. There were a larger proportion of patients achieving CDAI and DAS28 remission in the early versus late period (p < 0.0002 for both). There was significant improvement when using combination MTX and HCQ, however sample size was small (n = 9). The use of intra-articular steroids with MTX yielded the most disease measures that demonstrated early significant improvement.
  
  
  
  Subcutaneous MTX is rapid, as the change in many disease activity scores was significantly greater between 0-6 weeks compared to 6-12 weeks. Combination MTX + HCQ gave added value, although generalizability is limited by combination cohort sample size. Intra-articular steroid injections may contribute to the early effect.
authors: Schulich School of Medicine & Dentistry, University of Western Ontario, 268 Grosvenor St, London, ON, N6A 4V2, Canada.
authors: Anna
authors: A
authors: O'Connor
authors: Southlake Regional Health Centre, Newmarket, Canada.
authors: Carter
authors: C
authors: Thorne
authors: University of Toronto, Toronto, ON, Canada.
authors: Hyeon
authors: H
authors: Kang
authors: Southlake Regional Health Centre, Newmarket, Canada.
authors: Diane
authors: D
authors: Tin
authors: Schulich School of Medicine & Dentistry, University of Western Ontario, 268 Grosvenor St, London, ON, N6A 4V2, Canada. janet.pope@sjhc.london.on.ca.|University of Toronto, Toronto, ON, Canada. janet.pope@sjhc.london.on.ca.|Rheumatology, St. Joseph's Health Care, London, ON, Canada. janet.pope@sjhc.london.on.ca.
authors: Janet E
authors: JE
authors: Pope
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007270:Injections, Intra-Articular; D007279:Injections, Subcutaneous; D008297:Male; D008727:Methotrexate / Q000494:pharmacology* / Q000627:therapeutic use*; D008875:Middle Aged; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D008727:Methotrexate
keywords: ERA (early RA); Methotrexate; Optimal treatment strategy; Subcutaneous (sc)