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Limited benefits from methotrexate in adults with psoriatic arthritis
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Limited benefits from methotrexate in adults with psoriatic arthritis
Compared with placebo, leflunomide, ciclosporin A, gold and sulfasalazine, how effective is methotrexate for adult patients with psoriatic arthritis?
Low‐quality evidence suggested that low‐dose oral methotrexate might be more effective than placebo when taken for 6 months, in terms of disease response (number needed to benefit = 6), function, pain, and patient and physician global assessments of disease activity. The effect size for each of these outcomes was small. There were no clinically important differences with respect to disease response, disease activity, tender and swollen joint counts or skin disease. Methotrexate was generally well tolerated in this population. One study measured health‐related quality of life but did not report these results. The average age of people included in these studies varied from 26 to 52 years. The average duration of psoriatic arthritis ranged from 1 to 9 years. The dose of methotrexate consisted of 7.5mg to 25mg orally, but 15mg was given orally per week for most studies.
With the exception of leflunomide, head‐to‐head data were inadequate to inform comparison versus other disease-modifying antirheumatic drugs. Data comparing methotrexate versus leflunomide were of too low quality to provide clinically meaningful information. Effects of methotrexate on health‐related quality of life, radiographic progression, enthesitis, dactylitis and fatigue; methotrexate benefit beyond 6 months; and effects of higher‐dose methotrexate have not been measured or reported in a randomised placebo‐controlled trial.
Psoriatic arthritis is an inflammatory disease associated with joint damage, impaired function, pain and reduced quality of life. Methotrexate is a disease‐modifying antirheumatic drug commonly prescribed to alleviate symptoms, attenuate disease activity and prevent progression of disease.
Wilsdon TD et al. Methotrexate for psoriatic arthritis. Cochrane Reviews, 2019, Issue 1. Art. No.: CD012722.DOI: 10.1002/14651858.CD012722.pub2. This review contains 8 studies involving 572 participants.