CHICAGO—Methotrexate is a commonly used disease-modifying antirheumatic drug (DMARD) for treating patients with psoriatic arthritis (PsA). However, is it truly as effective as many think it is?
That’s the question that Gabrielle Kingsley, MB, PhD, consultant and reader in rheumatology at Kings College in London and Lewisham Healthcare NHS Trust, raised during the session, “Spondylarthropathies: Recent Insights,” which took place at the 2011 ACR/ARHP Annual Scientific Meeting in November. [Editor’s note: This session was recorded and is available via ACR SessionSelect at www.rheumatology.org.]
A number of PsA treatment guidelines include methotrexate, Dr. Kingsley said. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis recommend methotrexate to treat peripheral disease and skin and nail disease in PsA, she noted. Guidelines from the Scottish Intercollegiate Guidelines Network state that dermatology and rheumatology teams should work together to use methotrexate in PsA for the treatment of severe cutaneous psoriasis and peripheral disease. Recommendations from the European League Against Rheumatism published last year also provide a role for methotrexate in PsA after nonsteroidal antiinflammatory drugs (NSAIDs) and glucocorticoid injections are used, Dr. Kingsley said.
“All of these guidelines have methotrexate, which implies a strong evidence base. The reality is somewhat different,” she said. Dr. Kingsley went on to explain that methotrexate seems to help symptoms in PsA patients but does not usually improve patient outcomes.
Dr. Kingsley reviewed the results of the Norwegian NOR-DMARD study that included 430 patients with PsA and 1,218 with rheumatoid arthritis (RA).1 Because it is known that methotrexate is effective in RA patients, it would make sense that it would have a similar effect on PsA patients, Dr. Kingsley said. The study found similar improvements in most measures for both patient groups, but when the data were adjusted for baseline, gender, and other factors, there was less improvement in the PsA patients, she said. However, changes were within the same range as they were for RA patients.
Dr. Kingsley then spoke of a randomized clinical trial in which she was involved that compared methotrexate with placebo in 221 PsA patients. Half of the patients had 15 mg of methotrexate a week, while the other half had the placebo. The investigators then looked at composite measures over six months.
The researchers found that, while methotrexate made improvements in symptom modification, it did not make statistically significant improvements with outcomes such as swollen joint count and tender joint count.
