CAN METHOTREXATE BE USED AS A STEROID-SPARING AGENT IN THE TREATMENT OF POLYMYALGIA-RHEUMATICA AND GIANT-CELL ARTERITIS

Objective-To investigate whether methotrexate (MTX) has a steroid spar ing effect in the treatment of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). Methods-We carried out a randomised double blind , placebo controlled study in 40 patients with PMR, six of whom also h ad clinical symptoms of GCA. A temporal artery biopsy specimen was ava ilable from 37 patients; GCA was found in six of the specimens. Among the six patients with clinical signs of GCA, three had a positive biop sy specimen. All patients were started on prednisone 20 mg/day, irresp ective of clinical signs and biopsy result, supplemented with a weekly , blinded capsule containing either MTX 7.5 mg or placebo. The prednis one dose was decreased as soon as clinical symptoms disappeared and er ythrocyte sedimentation rate, C reactive protein level, or both, had n ormalised. Results-Twenty one patients were followed for two years, or at least one year after discontinuing medication. No differences were found between the MTX group and the placebo group concerning time to achieve remission, duration of remission, number of relapses, or cumul ative prednisone doses. After 21 weeks the mean daily prednisone dose was reduced by 50%. Ferry percent of all patients were able to discont inue prednisone within two years. Median duration of steroid treatment was 47.5 weeks (range 3-104). No serious complications from GCA were encountered. Conclusions-With a (rapid) steroid tapering regimen, it w as possible to reduce the mean daily prednisone dose by 50% in 21 week s and to cease prednisone in 40% of the patients within two years. Wit h this regimen, no steroid sparing effect of MTX in a dosage of 7.5 mg /week was found.