Efficacy of methotrexate in the treatment of ankylosing spondylitis: a three-year open study

• Published in: Clinical rheumatology 2000-01, Vol.19 (2), p.114-117
• Main Authors: Biasi, D, Carletto, A, Caramaschi, P, Pacor, M L, Maleknia, T, Bambara, L M
• Format: Article
• Language: English
• Subjects: Adult; Alanine Transaminase - blood; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antirheumatic Agents - adverse effects; Antirheumatic Agents - therapeutic use; Aspartate Aminotransferases - blood; C-Reactive Protein - metabolism; Drug Evaluation; Drug therapy; Drug Therapy, Combination; Female; Humans; Indomethacin - therapeutic use; Male; Methotrexate - adverse effects; Methotrexate - therapeutic use; Middle Aged; Pain Measurement; Safety; Spondylitis, Ankylosing - blood; Spondylitis, Ankylosing - drug therapy; Spondylitis, Ankylosing - physiopathology; Sulfasalazine - therapeutic use
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s100670050027

The aim of the study was to evaluate the efficacy of methotrexate treatment in patients with ankylosing spondylitis in a 3-year open trial. Seventeen patients, 14 men and three women (mean age 32.7+/-8.9 years), suffering from ankylosing spondylitis and non-responders to treatment with sulphasalazine, were enrolled in our study. Sixteen of them were evaluable at the end of the study. Methotrexate (7.5-10 mg/week) was administered for 3 years. Efficacy was evaluated on the basis of clinical and laboratory variables, radiographic signs of disease progression and daily dosage of indomethacin. We obtained a good and relatively prompt clinical response except for peripheral arthritis and iridocyclitis; in fact, after 3 months of methotrexate treatment a significant amelioration of the following parameters was observed: visual analogue scale for the evaluation of both night pain and general well-being, Shober's test, occiput-wall distance, fingertip to floor, erythrocyte sedimentation rate, C-reactive protein level and daily dose of indomethacin. A further improvement was obtained during the subsequent period. Radiographs of the spine and sacroiliac joints did not show any signs of disease progression. Side-effects were a transitory elevation of transaminases (four cases) and slight hypogammaglobulinaemia (one case). Methotrexate treatment may be useful in ankylosing spondylitis, but a combined treatment might be indicated for patients with peripheral arthritis.