Drug May Have No Benefit in PsA

Psoriatic arthritis patients may not benefit from methotrexate

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Methotrexate (sold as Rheumatrex and Trexall) may be the first-choice drug for treating rheumatoid arthritis. But how does it fare in patients with psoriatic arthritis? A recent study found no evidence that methotrexate improves joint inflammation in people with psoriatic arthritis.

"Work with your doctor to find the right arthritis drug for you."

Gabrielle H. Kingsley, MD, of King's College London, and colleagues found that methotrexate did not significantly change swelling in psoriatic arthritis patients.

Methotrexate did not have a significant effect on ACR20 (a score that indicates 20 percent improvement in tender or swollen joints) nor on DAS-28 (a measure of arthritis disease activity that includes a maximum of 28 joints).

The researchers also found that psoriatic arthritis patients taking methotrexate did not have significant improvements in pain, number of tender and swollen joints or levels of proteins associated with inflammation (measured as C-reactive proteins and erythrocyte sedimentation rate).

According to the authors, these findings raise questions about using methotrexate as a disease-modifying drug in patients with psoriatic arthritis.

Still, these results do not rule out the use of methotrexate in psoriatic arthritis. The sample size of the study was small. As Maxime Dougados, MD, of Réne Descartes University in Paris, pointed out in an editorial, the measures used to include or exclude patients from the study could have been different.

Two benefits of methotrexate found in this study were in patients' own rating of their arthritis (ie, patient global score) and in doctors' rating of arthritis (ie, physician global score).

Patients taking methotrexate also had improved skin health.

In addition, the researchers found no unexpected side effects.

This six-month study compared the effects of methotrexate with placebo in 221 patients with psoriatic arthritis - a form of arthritis that develops in people with a skin condition called psoriasis.

The research received support from Arthritis Research UK, the National Institute for Health Research in the UK, and the UK Medical Research Council.

One of the study's authors has received support from Abbott Laboratories and Pfizer.

The study was published February 17 in the journal Rheumatology.

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Review Date: 
July 28, 2012
Last Updated:
October 16, 2012