Longterm methotrexate therapy in psoriatic arthritis: clinical and radiological outcome

To determine whether methotrexate (MTX) therapy for 24 months prevents progression of radiographic damage in psoriatic arthritis (PsA).

Patients who were given MTX during their attendance at the psoriatic arthritis clinic were enrolled in the study. Patients who had never had MTX and who were matched by damage, actively inflamed joints, sex, and disease duration were identified from the PsA database as controls. The outcome measure was increase in the number of damaged joints.

The study population comprised 38 patients (16 F, 22 M) with a mean age of 44.6 years and disease duration of 11.4 years. Twenty-three patients continued therapy for 24 months. Clinical evaluation revealed that 45% of the patients had > or = 40% improvement in actively inflamed joint count at 6 and 24 months. Radiographs were available for 19 of the 23 patients who took MTX for 24 months, and they were compared to their respective controls. Radiographic damage scores at 24 months showed an increase in the damage score in 63% of the patients. Compared to the matched controls, there was no statistically significant difference in the progression in damage.

Our results suggest that compared to other regimens, MTX conferred no advantage with respect to clinical response or longterm damage even after 24 months of therapy.