Influence of methotrexate on radiographic progression in rheumatoid arthritis: a sixty-month prospective study.

Author(s): Drosos AA, Tsifetaki N, Tsiakou EK, Timpanidou M, Tsampoulas C, Tatsis CK, Kotoulas K, Moutsopoulos HM

Affiliation(s): Department of Internal Medicine, University of Ioannina, Greece.

Publication date & source: 1997-05, Clin Exp Rheumatol., 15(3):263-7.

Publication type: Clinical Trial; Randomized Controlled Trial

OBJECTIVE: To evaluate if methotrexate (MTX) can slow disease progression, as determined radiographically, in comparison to other disease modifying drugs in rheumatoid arthritis (RA) patients. MATERIALS AND METHODS: Pairs of hand and wrist radiographs from 30 patients treated with MTX and 30 treated with D-penicillamine (DP) were evaluated blindly and separately by two radiologists (A and B) using reference radiographs for scoring. A scale scoring similar to Larsen's standard radiographs with minor modifications was used. The radiographs studied were obtained at the beginning and 5 years after therapy in both groups. RESULTS: A significantly greater worsening was found in the DP-treated patients (p = 0.025), as compared to MTX patients. Methotrexate showed a slower rate of disease progression than DP. Furthermore, in the MTX group 15 patients remained radiographically stable, 9 worsened and 6 were healed. In contrast, in the DP group 22 patients remained radiographically stable, 8 worsened and none improved. CONCLUSIONS: The rate of radiographic progression in RA patients was lower in MTX-treated patients compared to those treated with DP. Six patients showed radiological improvement after MTX treatment. Therefore, it seems that MTX could be considered a disease modifying drug.