Methotrexate in the treatment of rheumatoid arthritis

Author and Disclosure Information


The spectrum of disease severity in rheumatoid arthritis is as varied as the number of people who are afflicted with the disease. Many patients with rheumatoid arthritis require only supportive therapy consisting of rest, physical therapy, and salicylates or nonsteroidal anti-inflammatory drugs. A few patients with more active disease require suppressive drugs and highly anti-inflammatory drugs such as hydroxychloroquine, parenteral gold, penicillamine and/or low-dose corticosteroids. A minority of patients have severe, progressive disease that does not respond to these more conservative measures. For these patients with malignant rheumatoid arthritis more effective but more dangerous drug choices exist. These are the immunosuppressive cytotoxic drugs.

Cyclophosphamide, an alkylating agent, and azathioprine, a purine analogue, have both been shown to suppress the activity of rheumatoid arthritis.1–4 Unfortunately, these drugs are not without short- and long-term hazards. The folic acid antagonist methotrexate has not been studied in the treatment of rheumatoid arthritis despite the fact that its short-term toxicity can usually be controlled and its long-term toxicity, with special regard to carcinogenicity, appears to be negligible.5–10 Methotrexate, however, has been found useful in the treatment of psoriatic arthritis.11, 12

The present study was designed to investigate the short-term efficacy and toxicity of low doses of oral methotrexate in the treatment of active rheumatoid arthritis.

Materials and methods

The study population consisted of six patients whose sex, age, duration of disease, total American Rheumatism Association criteria and drug therapy are given in the Table. All patients had classic or definite rheumatoid arthritis. In . . .



Next Article: