title: Methotrexate impact on radiographic progression in biologic-treated rheumatoid arthritis under clinical remission: A case report on monozygotic Caucasian twins.
abstract: We describe Caucasian monozygotic twin brothers with rheumatoid arthritis (RA) and discuss influence of predictors to methotrexate (MTX) outcome treatment. Single nucleotide polymorphisms (SNPs) of the MTX metabolic pathways were genotyped. Twins have multiple mutations: a CC mutation of SNP 1298A>C in methylenetetrahydrofolate reductase (MTHFR) gene, CC mutations of three SNPs in the adenosine receptor gene ADORA2A (rs3761422_4217241T>C, rs2267076_4221164T>C, rs2236624_4226593T>C), and a heterozygous genotype in SNPs ATIC_rs2372536_347C>G, MTHFD1_rs2236225_1958G>A. These mutations are known to predict a worse outcome of MTX treatment. The twins had different lifestyles (alcohol drinking and smoking in Twin 1, regular coffee consumption in Twin 2), but a very similar clinical presentation of the outset of RA, radiographic scoring according to the Sharp/van der Heijde method with an almost identical antibodies presentation. The period of the patients before anti-TNFα treatment was characterized by unsuccessful per oral MTX pharmacotherapy in both cases (a low effect of MTX in Twin 1; an early discontinuation of MTX due to an adverse event in Twin 2). In both twins, the outcome of well-controlled anti-TNFα treatment (co-medication with MTX in Twin 1) for 10 years was expressed as low disease activity measured using composite index DAS28. It is interesting that Twin 2 had an unfavorable radiographic scoring after a 10-year follow-up than Twin 1 in spite of the comparable DAS28 in Twin 2 and smoking in Twin 1. In conclusion, co-medication of MTX with biologics may impact on RA radiographic progression despite predicted bad MTX outcome based on pharmacogenetic analysis.
authors: Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, 2nd Department of Internal Medicine - Gastroenterology, Hradec Kralove, Czech Republic.
authors: Tomas
authors: T
authors: Soukup
authors: Charles University in Prague, University Hospital in Hradec Kralove, Institute of Clinical Biochemistry and Diagnostics, Hradec Kralove, Czech Republic.
authors: Jana
authors: J
authors: Nekvindova
authors: Charles University in Prague, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy, Hradec Kralove, Czech Republic martin.dosedel@faf.cuni.cz.
authors: Martin
authors: M
authors: Dosedel
authors: Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Radiology, Czech Republic.
authors: Jindra
authors: J
authors: Brtkova
authors: Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, 2nd Department of Internal Medicine - Gastroenterology, Hradec Kralove, Czech Republic.
authors: Jan
authors: J
authors: Toms
authors: Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, 2nd Department of Internal Medicine - Gastroenterology, Hradec Kralove, Czech Republic.
authors: Drahomira
authors: D
authors: Bastecka
authors: Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, 2nd Department of Internal Medicine - Gastroenterology, Hradec Kralove, Czech Republic.
authors: Petr
authors: P
authors: Bradna
authors: Charles University in Prague, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy, Hradec Kralove, Czech Republic.
authors: Jiri
authors: J
authors: Vlcek
authors: Charles University in Prague, Faculty of Pharmacy in Hradec Kralove, Department of Pharmacology and Toxicology, Hradec Kralove, Czech Republic.
authors: Petr
authors: P
authors: Pavek
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology*; D001688:Biological Products / Q000627:therapeutic use*; D018450:Disease Progression; D004359:Drug Therapy, Combination / Q000379:methods; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D020641:Polymorphism, Single Nucleotide / Q000235:genetics; D016896:Treatment Outcome; D014430:Twins, Monozygotic; D044465:White People / Q000235:genetics
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D008727:Methotrexate
keywords: methotrexate; pharmacogenetics; rheumatoid arthritis; twins