Effect of low dose methotrexate as an add-on therapy in patients with palindromic rheumatism unresponsive to hydroxychloroquine: An observational study
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Prasanta Padhan1, Bhaskar Thakur2
1Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India.
Objective:
Palindromic rheumatism (PR) is characterized by repetitive attacks of arthritis and/or periarthritis. There is inadequate data regarding the role of low dose methotrexate in patients with PR. The aim of this study was to determine the efficacy of low dose methotrexate add-on therapy in patients withPR with inadequate response to hydroxychloroquine (HCQ) monotherapy.
Methods:
In this observational study, between August 2016 and July 2019, 15 patients with seropositive PR with inadequate response to HCQ (≥ 2attacks per month even after 6 months of therapy) were included. All patients were treated with oral low dose methotrexate in addition to HCQ. The responses to therapy were monitored 3 and 6 months after adding methotrexate.
Results:
In our study, of the 15 patients with PR, two-third were female, with a mean age of 45.73±9.18 years. All were seropositive (Rheumatoid factor positive in eight patients; anti-cyclic citrullinated peptide [CCP] positive in 11 patients; both Rheumatoid factor and anti-CCP positive in four patients). The average number of attacks at baseline was 5.6±2.8, and the median duration of attacks was 2 years. All patients had significant response to add-on methotrexate therapy at follow-up after 3 and 6 months; none developed Rheumatoid arthritis (RA) after 2 years of follow-up.
Conclusion:
Low dose methotrexate is an effective add-on therapy in patients with PR having inadequate response to HCQ.
Insights
Low dose methotrexate effectively treated palindromic rheumatism (PR) in patients unresponsive to hydroxychloroquine (HCQ). This add-on therapy reduced disease activity and prevented progression to rheumatoid arthritis (RA).
Area of Science:
- Rheumatology
- Immunology
Background:
- Palindromic rheumatism (PR) involves recurrent arthritis attacks.
- Limited data exists on low-dose methotrexate for PR.
- Hydroxychloroquine (HCQ) monotherapy may be insufficient for some PR patients.
Purpose of the Study:
- To evaluate the efficacy of low-dose methotrexate as an add-on therapy for PR patients with inadequate response to HCQ.
- To assess the impact of methotrexate on disease activity and progression.
Main Methods:
- Observational study of 15 seropositive PR patients from August 2016 to July 2019.
- Patients received oral low-dose methotrexate in addition to HCQ.
- Therapeutic response monitored at 3 and 6 months.
Main Results:
- Two-thirds of the 15 patients were female, with a mean age of 45.73 years.
- All patients were seropositive for Rheumatoid Factor and/or anti-CCP antibodies.
- Significant response to add-on methotrexate was observed at 3 and 6 months; no patients progressed to Rheumatoid Arthritis (RA) within 2 years.
Conclusions:
- Low-dose methotrexate is an effective add-on treatment for palindromic rheumatism patients inadequately managed by HCQ monotherapy.
- Methotrexate can help control disease activity and potentially prevent progression to RA.
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