Methotrexate in rheumatoid arthritis

Article Abstract:

Rheumatoid arthritis (RA) is a joint disease characterized by inflammation of the joints, stiffness, swelling, overgrowth of cartilage tissue, and pain. Recent advances in the treatment of RA include the development of nonsteroidal anti-inflammatory drugs and pulse intravenous cyclophosphamide, which consists of intermittent doses administered directly into the circulation. Methotrexate, a drug used to treat some cancers and psoriasis, a skin disease, is currently being assessed worldwide for its effectiveness in treating RA. This drug was shown to be rapid in action, producing effective results within four weeks in some cases. Some patients may need higher doses of 15 to 25 milligrams methotrexate weekly, or injection of the drug directly into the muscle to improve its distribution in tissues. Methotrexate improves all symptoms of RA, and many patients may no longer need steroid therapy. The drug is eliminated by the kidney, and must be used with caution in patients with impaired kidney function. It is shown to be more acceptable to patients than other anti-rheumatic agents. Methotrexate should not be used during pregnancy or with excessive alcohol intake, and discontinuation of the drug may result in recurrence and worsening of RA. Methotrexate interacts with drugs that bind protein, and has been shown to have toxic effects on the liver and lungs. In conclusion, current studies indicate that methotrexate is rapid and effective in treating RA. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation

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Two methods of assessment of methotrexate hepatotoxicity in patients with rheumatoid arthritis

Article Abstract:

Microcomputer image analysis and a grading system with a regular microscope were used to assess changes in liver tissue structure in 18 patients (11 female) with rheumatoid arthritis. All patients had been treated with low doses of methotrexate for a least one year. Using a regular microscope, mild-to-moderate fatty change was observed in 14 liver samples and mild-to-moderate fibrosis was found in 15 samples. No changes were severe enough to warrant discontinuation of methotrexate. Levels of collagen, a structural protein indicative of fibrotic changes, were evaluated by image analysis. Significant increases in collagen were observed in samples taken after the start of methotrexate therapy. The increases were observed in three different areas of the liver: those surrounding liver cells, liver veins, and the portal tract (vein which conveys blood from abdominal veins into the liver). Microscopic and image analysis results correlated significantly. Changes in collagen did not correlate with doses of methotrexate, suggesting that other factors in addition to this drug therapy contributed to liver fibrosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Causes of, Complications and side effects, Liver diseases, Diagnostic imaging

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Survival and drug discontinuation analyses in a large cohort of methotrexate treated rheumatoid arthritis patients

Article Abstract:

Patients with rheumatoid arthritis (RA) tolerate methotrexate therapy relatively well even after a 10-year course of treatment. Researchers evaluated the likelihood of 152 patients with RA continuing methotrexate therapy for a period of 10 years, documented any adverse side effects associated with the drug, and calculated survival rates. The overall likelihood of patients with RA still taking methotrexate after 10 years was 30%. The probability of survival at 10 years was 85% for women and 45% for men. The most common reason given for stopping methotrexate treatment was toxicity (53%). Of the 27 patients who died during the 10-year period, doctors attributed 3 deaths to methotrexate toxicity.

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