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Long-term outcome of patients with palindromic rheumatism treated with methotrexate
Arezoo Ghassembaglou1, Kamal Esalatmanesh2, Leyla Gadakchi1
1Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Objective:
Palindromic rheumatism (PR) is characterized by self-resolving and short duration attacks of arthritis/periarthritis. The present study was performed to report the results of PR treatment with methotrexate (MTX).
Methods:
We reviewed the charts of 152 patients with diagnosis of PR. Inclusion criteria were diagnosis of PR according to the criteria of Weismann, age ≥16, active disease and treatment with MTX for at least 6 months. Disease outcome was assessed by reaching remission and prevention of disease evolution to chronic arthritis. Remission was defined as stopping the attacks for 12 weeks and prednisolone dose ≤5 mg/d. MTX treatment failure was defined as failure to achieve remission, the need to add other disease-modifying antirheumatic drugs and disease progression to chronic arthritis.
Results:
Fifty-nine patients were included in the study. Median duration of follow-up was 43 months. Attacks were controlled in 89.8% of patients. In 80% of the patients remission occurred during 12 months after starting treatment with MTX. Treatment failed in 20.3% of patients. Wrist joint involvement and positive rheumatoid factor (RF) were significantly more common in the MTX treatment-failed group. In RF positive patients evolution to rheumatoid arthritis was more common than in RF negative patients. No significant differences were observed in remission rate and evolution to rheumatoid arthritis in anticitrullinated C peptide positive and negative patients.
Conclusions:
The present study, demonstrated the efficacy of MTX in controlling PR in seropositive and seronegative patients over a median of 43 months of treatment.
Insights
Methotrexate (MTX) effectively controls palindromic rheumatism (PR) attacks and induces remission in most patients. This treatment is beneficial for both rheumatoid factor-positive and negative individuals, preventing disease progression.
Area of Science:
- Rheumatology
- Immunology
- Pharmacology
Background:
- Palindromic rheumatism (PR) presents as recurrent, short-lived arthritis attacks.
- Effective long-term management strategies for PR are crucial to prevent chronic disease development.
Purpose of the Study:
- To evaluate the efficacy of methotrexate (MTX) in treating palindromic rheumatism (PR).
- To assess remission rates and disease progression in PR patients treated with MTX.
Main Methods:
- Retrospective chart review of 152 patients diagnosed with PR.
- Inclusion criteria: Weismann criteria for PR, age ≥16, active disease, and ≥6 months of MTX treatment.
- Outcomes assessed: remission (12 weeks attack-free, prednisolone ≤5 mg/d) and prevention of chronic arthritis.
Main Results:
- 89.8% of patients achieved control of arthritis attacks with MTX.
- 80% of patients reached remission within 12 months of MTX initiation.
- Treatment failure occurred in 20.3% of patients; wrist involvement and positive rheumatoid factor (RF) were associated with failure.
Conclusions:
- Methotrexate demonstrates significant efficacy in controlling palindromic rheumatism (PR).
- MTX is effective in achieving remission and preventing disease evolution in both seropositive and seronegative PR patients.
- Long-term (median 43 months) treatment with MTX shows sustained benefits in PR management.
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