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Methotrexate may affect joint erosions but not pain in patients with erosive hand OA



Dr. Roux noted the results from the ADEM trial were similar to a recent study in which 90 patients with hand OA were randomized to receive etanercept or placebo. At 24 weeks, there was no statistically significant difference between VAS pain in the etanercept group (between group difference, −5.7; 95% confidence interval, −15.9 to 4.5; P = .27) and the placebo groups, and at 1 year (between-group difference, –8.5; 95% CI, −18.6 to 1.6; P = .10), although the results favored patients receiving anti-tumor necrosis factor therapy (Ann Rheum Dis. 2018;77:1757-64. doi: 10.1136/annrheumdis-2018-213202).

With regard to the Verbruggen-Veys score, joint degradation was not significantly higher in the placebo group (29.4%), compared with the MTX group (7.7%), but there was a significantly higher number of erosive joints progressing to a remodeling phase in the MTX group (27.2%), compared with the placebo group (15.2%) at 12 months.

Dr. Roux said two factors are likely predictors of erosive disease based on data in ADEM: the level of interleukin-6 at baseline (odds ratio, 1.04; 95% CI, 1.03-1.06; P less than .0001), and joints with synovitis at baseline (OR, 4.7; 95% CI, 1.25-17.90; P = .02).

“Our study has several limitations, but we like to see our study as a pilot study,” he added, noting that a study analyzing bone turnover in patients with different doses of methotrexate and a longer disease duration is needed.

The authors reported no conflicts of interest.

SOURCE: Ferraro S et al. Arthritis Rheumatol. 2019;71(suppl 10), Abstract 1759.

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