Methotrexate for ankylosing spondylitis

Department of Hematology and Rheumatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China. .
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2013; 2(2):CD004524. DOI: 10.1002/14651858.CD004524.pub4
Source: PubMed


Researchers in the Cochrane Collaboration conducted a review about the effect of the drug methotrexate in people with ankylosing spondylitis (AS). They identified three studies, which included 116 participants, that met the inclusion criteria. The review shows that for people with AS: - methotrexate probably improves physical function but this may have happened by chance. - it is uncertain whether methotrexate will help to ease pain, tenderness, and swelling in the ligaments of the joints, movement of the spine, stiffness, or overall well-being because there were not enough participants studied. - it is uncertain whether methotrexate slows damage to the joints because the studies did not look at an x-ray of the spines of the people with AS. We often do not have precise information about side effects and complications. This is particularly true for rare but serious side effects. Possible side effects include stomach problems, mild headaches, mouth sores, changes in liver function, hair loss, or mild infections. Rare complications may include lung problems. It is important to keep medical appointments to catch any serious problems early. What is AS and what is methotrexate? AS is a type of arthritis that usually occurs in the joints and ligaments of the spine. It may also affect the shoulders, hips, or other joints. Pain and stiffness occurs and limits movement in the back and in other joints that are affected. Methotrexate (MTX) is a disease-modifying antirheumatic drug (DMARD). It is the most commonly used DMARD in people with inflammation in their joints. It works to control inflammation in affected joints to stop the pain and stiffness. MTX is taken once per week and may be administered in pill form or as an injection.


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    • "Possible reasons for this may be the younger age of the ax-SpA patients and socio-economical considerations; sufficient disease control may contribute to maintain work ability. Further, the effect of csDMARDs in ax-SpA is controversial; csDMARDs are not routinely prescribed for patients with only axial disease as they have not shown to be efficacious474849. Interestingly, the RA patients used significantly more steroids than the PsA and the ax-SpA patients. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective The main objective of this study was to compare disease burden in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (ax-SpA). Methods In this cross-sectional study, all the RA (1093), PsA (365) and ax-SpA (333) patients who visited the out-patient clinic of the Hospital of Southern Norway Trust during the year 2013 were included; the RA patients all had a RA diagnosis verified by the treating rheumatologist, the PsA patients all fulfilled the ClASsification for Psoriatic ARthritis (CASPAR) criteria and the ax-SpA patients all fulfilled the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for ax-SpA. Patient-reported health status, demographic variables, medications, and composite scores of disease activity were assessed. The main analyses were performed using General Linear Models adjusted for age, sex and multiple comparisons. Correlation analyses were performed using Spearman’s rho. Results The reported pain, joint pain, patient’s global assessment and fatigue were similar in PsA and ax-SpA, but significantly lower in RA. The 28-joint Disease Activity Score (DAS28) (0.3±0.1, p = 0.003), Clinical Disease Activity Index (CDAI) (1.0±0.4, p = 0.028) and Routine Assessment of Patient Index Data 3 (RAPID3) (0.4±0.1, p = 0.004) were all significantly higher in PsA vs. RA. RAPID3 showed moderate to high correlation with DAS28 (rho = 0.521, p<0.001) and CDAI (rho = 0.768, p<0.001) in RA and PsA, and with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (rho = 0.902, p<0.001) and Bath Ankylosing Spondylitis Functional Index (BASFI) (0.865, p<0.001) in ax-SpA and PsA. Conclusion In conclusion, patient- reported outcome measures were similar in our population of PsA and ax-SpA patients, but significantly lower for the RA patients. Composite disease activity measures were lower in RA than in PsA and ax-SpA, but the magnitude of these differences was small and probably not of clinical significance. Our study indicates that disease burden in RA, PsA and ax-SpA may be more similar than previously demonstrated.
    Full-text · Article · Apr 2015 · PLoS ONE
  • [Show abstract] [Hide abstract] ABSTRACT: Ankylosing spondylitis (AS) is an inflammatory rheumatologic disease characterized by inflammation and progressive structural damage of the affected joints. Hip involvement often results in severe deformities and significant impairment on function. Although, tremendous progress has been made in conservative management for AS, effective prevention strategies for hip involvement and long-term need for total hip arthroplasty (THA) remain indefinite. When hip involvement has progressed to intractable pain and disability, THA is still the most effective treatment strategy to relieve pain and restore function. However, certain AS-specific problems regarding "preoperative preparation," "intraoperative difficulties," "perioperative pharmacological management," "postoperative physiotherapy," "operation benefits," and "operation complications" need more concern and further discussion.
    No preview · Article · Apr 2013 · Clinical Rheumatology
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    [Show abstract] [Hide abstract] ABSTRACT: Although TNF-α inhibitors' striking effect on clinical symptoms have revolutionised the treatment of ankylosing spondylitis (AS), no certain influence on the development of spinal ankylosis and joint destruction has been documented. We wished to investigate whether improved treatment has affected the use of hip arthroplasty surgery. Using the Norwegian Arthroplasty Register, we selected hip prosthesis procedures performed in patients with AS in 1988-2010 (n=534), and compared the trend in the number of procedures being performed annually in 1988-2002 versus 2003-2010. Patients with osteoarthritis (OA) (n=95094) were used as a control group. The frequency of hip prosthesis surgery increased significantly in both groups up until 2002. In 2003-2010, although not statistically significant (p=0.087), there was a trend towards a reduced frequency in the AS group when compared with the expected continued increase as was seen among patients with OA. Mean age at surgery increased significantly (p<0.001) from 49.9 years to 56.4 years when comparing patients with AS up until and after 2002. TNF-α inhibitors were introduced to patients with AS in Norway in 2000-2003, and our findings suggest that they may have altered the prognosis by inhibiting or slowing large joint arthritis and thus reducing the need for hip replacement surgery.
    Full-text · Article · Nov 2013 · Annals of the rheumatic diseases
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