Reappraisal of the Effectiveness of Methotrexate in Psoriatic Arthritis: Results from a Longitudinal Observational Cohort

VINOD CHANDRAN, CATHERINE T. SCHENTAG, and DAFNA D. GLADMAN

ABSTRACT.

Objective. In a previous study in our clinic, methotrexate (MTX) conferred no advantage with respect to clinical response or progression of damage after 24 months in patients with psoriatic arthritis (PsA). Our aim was to determine if MTX is being used earlier in the course of PsA and in a higher dose and whether that has led to improved outcomes.

Methods. All patients treated with MTX for at least 24 months in our clinic, between 1994 and 2004, were included in the study. The outcome measures were the progression of radiographic peripheral joint damage score and a ≥ 40% reduction in the number of actively inflamed joints. The data from our study were compared to those obtained from our previous study.

Results. Fifty-nine patients (36 men) treated with MTX for 24 months were identified. The mean age was 46 years, PsA duration 8 years, and active joint count 12.1 (4.6 swollen). The mean increase in radiographic damage score was 1.5. Sixty-eight percent of patients demonstrated improvement at 24 months. When compared to our previous study, there was a trend for MTX to be used earlier, at a higher dose, with greater clinical improvement and less progression of damage.

Conclusion. Our study suggests that treatment with MTX has changed in the past decade to include patients with shorter disease duration and less damage, at increased dose, and that there may be better response with less progression of damage. (First Release Dec 15 2007; J Rheumatol 2008;35:469-71)

Key Indexing Terms:

PSORIASIS
ANTIRHEUMATIC AGENTS
METHOTREXATE

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From the University of Toronto Psoriatic Arthritis Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.

Dr. Chandran is supported by The Arthritis Society (Metro A. Ogryzlo International Fellowship), The Arthritis Centre for Excellence, and the Krembil Foundation Psoriatic Arthritis Fellowship. The University of Toronto Psoriatic Arthritis Program is supported by the Krembil Foundation.

V. Chandran, MBBS, MD, DM, Clinical Research Fellow; C.T. Schentag, MSc, Research Associate; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Toronto Western Research Institute.

Address reprint requests to Dr. D.D. Gladman, Toronto Western Research Institute, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 399 Bathurst Street, 1E-410B, Toronto, Ontario M5T 2S8. E-mail:dafna.gladman@utoronto.ca

Accepted for publication October 4, 2007.

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