Recommendations for the use of methotrexate in psoriatic arthritis (original) (raw)
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A randomized placebo-controlled trial of methotrexate in psoriatic arthritis
Rheumatology (Oxford, England), 2012
MTX is widely used to treat synovitis in PsA without supporting trial evidence. The aim of our study was to test the value of MTX in the first large randomized placebo-controlled trial (RCT) in PsA. A 6-month double-blind RCT compared MTX (15 mg/week) with placebo in active PsA. The primary outcome was PsA response criteria (PsARC). Other outcomes included ACR20, DAS-28 and their individual components. Missing data were imputed using multiple imputation methods. Treatments were compared using logistic regression analysis (adjusted for age, sex, disease duration and, where appropriate, individual baseline scores). Four hundred and sixty-two patients were screened and 221 recruited. One hundred and nine patients received MTX and 112 received placebo. Forty-four patients were lost to follow-up (21 MTX, 23 placebo). Twenty-six patients discontinued treatment (14 MTX, 12 placebo). Comparing MTX with placebo in all randomized patients at 6 months showed no significant effect on PsARC [odd...
METHOTREXATE USE IN PSORIASIS AND PSORIATIC ARTHRITIS
Rheumatic Disease Clinics of North America, 1997
Methotrexate (MTX) has become the cornerstone in the therapy of a variety of inflammatory disorders affecting the skin and joints. In this regard, the anti-inflammatory efficacy of the compound was first shown in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA).28From the beginning, MTX was recognized as a highly efficacious and safe agent in the treatment of both psoriasis and PsA. Its overuse during the 1960s, however, led to the development of some serious toxicity, including liver cirrhosis and bone narrow suppression, resulting in concern about its safety. This concern has subsided in the past several years, and MTX has become the most commonly prescribed agent in several chronic arthritides.10 and 29A complete discussion of the available therapeutic modalities for psoriasis and PsA is beyond the scope of this article. Treatment of these disorders includes pharmacologic, rehabilitative, and surgical reconstructive therapies.14, 18, 19 and 25The main therapeutic goals are suppression of both skin and joint inflammation, preservation of musculoskeletal function, and prevention of joint deformity and disability. To accomplish these objectives, a multidisciplinary approach involving the close collaboration of dermatologists, rheumatologists, primary care physicians, orthopedists, and rehabilitation personnel is required. An improved understanding of the pathogenic mechanisms and immunogenetic and clinical features of psoriasis and PsA provides a solid basis for the comprehensive therapeutic management of these disorders.15 and 27
Annals of the Rheumatic Diseases, 2010
Objective To examine the effectiveness and 2-year retention rates of methotrexate (MTX) in MTX naïve patients with psoriatic arthritis (PsA). Methods Data on 430 patients with PsA participating in an ongoing longitudinal observational multicentre study in Norway were analysed. 1218 MTX naïve patients with rheumatoid arthritis (RA) from the same study served as a reference population. Assessments included measures of disease activity (28 joint counts, acute phase reactants), health status and utility scores. Six-month effectiveness data were compared both by crude analyses and with adjustments for age, sex and the respective baseline values. Two-year drug survival was compared by Kaplan-Meier and Cox regression analyses. Results After 6 months of MTX treatment, both patients with PsA and those with RA improved in most disease activity measures and patient reported outcomes. In the adjusted analysis, patients with PsA tended to have less improvement, but changes were in the same range as in patients with RA. Two-year retention rates of MTX therapy in patients with PsA and RA were 65% and 66%, respectively, with only minor differences in reported reasons for discontinuation. Lower age, longer disease duration and higher Modifi ed Health Assessment Questionnaire (MHAQ) score and patient global assessment were independent predictors of MTX termination within the fi rst 2 years of treatment. Conclusion In this real-life study, MTX treatment was associated with improvement in disease activity and health-related quality of life in patients with PsA after 6 months of treatment. Retention rates of MTX were similar in PsA and RA. Psoriatic arthritis (PsA) is a chronic infl ammatory joint disease prevalent in up to one-third of patients with psoriasis. 1 2 It is increasingly being recognised as a severe form of arthritis, and studies have shown that erosive progression and disability are quite frequent. 3-5 The effi cacy of tumour necrosis factor α (TNFα) inhibitors in PsA is well documented in randomised controlled trials (RCTs). 6-8 The introduction of these agents has represented major progress in the treatment of PsA and has also led to increased interest in the mechanisms and management of the disease. However, biological agents are costly and normally restricted to patients who have failed conventional therapy with one or more non-biological disease-modifying anti-rheumatic drugs (DMARDs). Thus, optimal use of DMARDs is important.
Effectiveness, Safety and Tolerance of Methotrexate in Vietnamese Psoriatic Arthritis Patients
Open Access Macedonian Journal of Medical Sciences
AIM: To access the effectiveness, safety and tolerance of methotrexate (MTX) in psoriatic arthritis (PsA) treatment. METHODS: We recruit 37 patients, admitted at HCMC Hospital of Dermato-Venereology from 1/2016 to 3/2017, with MTX dosage ranging from 10 mg to 15 mg per week. RESULTS: Skin lesion response after 12 weeks improved PASI 50: 40.5%, PASI 75: 24.3%. Disease activity score decreased after 12 weeks with ∆DAS28 = -1.43 + 0.79, 37.8% PsA achieved complete remission. Nausea and vomiting were 8.1%. These symptoms were mild and transient. We did not stop MTX usage. The rate of elevating SGPT 2-3 times as much as the upper limit of the normal range was 2.7%. CONCLUSION: We finally demonstrated that the rate of treatment response in Vietnam is the same as demonstrated by foreign authors in other countries.
Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference
Journal of the American Academy of Dermatology, 2009
Background: Methotrexate remains a valuable option for the treatment of psoriasis. This report will summarize studies regarding the use of methotrexate since the last guidelines were published in 1998. Objective: A task force of the National Psoriasis Foundation Medical Board was convened to evaluate treatment options. Our aim was to achieve a consensus on new updated guidelines for the use of methotrexate in the treatment of psoriasis. Methods: Reports in the literature were reviewed regarding methotrexate therapy. Results: A consensus was achieved on use of methotrexate in psoriasis including specific recommendations on dosing and monitoring. The consensus received unanimous approval from members of the Medical Board of the National Psoriasis Foundation. Limitations: There are few evidence-based studies on the treatment of psoriasis with methotrexate. Many of the reviewed reports are for the treatment of rheumatoid arthritis. Conclusions: Methotrexate is a safe and effective drug for the treatment of psoriasis. Appropriate patient selection and monitoring will significantly decrease the risks of side effects. In patients without risk factors for hepatic fibrosis, liver biopsies may not be indicated or the frequency of liver biopsies may be markedly reduced.
Drug use and toxicity in psoriatic disease: focus on methotrexate
The Journal of Rheumatology, 2008
Methotrexate (MTX) toxicity in psoriatic disease was the focus of discussion at the 2007 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Plenary presentations and results of a Web-based opinion survey of rheumatologists and dermatologists from GRAPPA, and others from New Zealand, Australia, and Canada, provided topics of discussion for small-group breakout sessions, including hepatotoxicity, alcohol use, fertility and pregnancy, and combination therapy. As a framework, topics were considered under headings: importance, knowledge deficit, sufficient data for a recommendation, and research agenda. Breakout session conclusions/consensus were as follows: (1) Data are insufficient to recommend routine serial liver biopsy to prevent MTX-induced liver fibrosis; further research is needed to establish whether serial liver chemistry tests or propeptide of type III collagen can detect hepatotoxicity without the need for liver biopsy.
Multidisciplinary focus on methotrexate in psoriatic disesase
The Journal of rheumatology. Supplement, 2009
The aim of this focus is to establish the role of methotrexate (MTX) in the treatment of psoriatic disease (PD). Despite the lack of hard evidence, MTX can be regarded as the nonbiological drug of choice for the treatment of peripheral psoriatic arthritis, although its effect on psoriatic dactylitis, enthesitis, and spondylitis needs to be further studied by means of well conducted clinical trials. MTX is effective in improving the skin involvement of PD, and can be used in moderate to severe psoriasis before starting a biological agent. Although rheumatologists consider it relatively safe in PD, dermatologists are very concerned about its toxicity and so, until more definite data are available, precautions should be taken to prevent MTX-induced liver fibrosis and cirrhosis.
Rheumatology, 2018
Objective Despite the widespread clinical use of MTX in PsA, data from published randomized controlled studies suggest limited efficacy. The objective of the present study was to document the efficacy of MTX. Methods This was an open-label, prospective study of patients satisfying the ClASsification criteria for Psoriatic ARthritis study (CASPAR) criteria for PsA who received MTX in doses of ⩾15 mg/week throughout the follow-up period of 9 months. Disease activity was assessed across various domains by tender and swollen joint count, physician and patient global assessment, DAS-28 ESR, Clinical Disease Activity Index for PsA (cDAPSA), Leeds Dactylitis Instrument basic, Leeds Enthesitis Index (LEI), Psoriasis Area and Severity Index (PASI), Minimal Disease Activity and HAQ (CRD Pune version) at baseline and at 3, 6 and 9 months of follow-up. Response to therapy was assessed by EULAR DAS28 ESR, Disease Activity Index for PsA (cDAPSA) response, HAQ response and PASI75. MTX dose escalat...