EFFICACY AND HEPATOTOXIC EFFECTS OF METHO TREXATE IN RHEUMATOID-ARTHRITIS

The efficacy and toxicity (specially hepatic) of methotrexate in low d oses (7.5 mg/week) was prospectively assessed in 21 patients with rheu matoid arthritis refractory to treatment with gold or penicillamine, d uring two years. Three patients were prematurely withdrawn from the pr otocol A fast and significant improvement of RA was observed during th e first six months, which tapered thereafter Erythrocyte sedimentation rate decreased from 51.5 +/- 20.1 to 27.7 +/- 11.5 mm/h (p < 0 05). A rise in serum transaminases, always raising to less than twice the no rmal value, was observed in 75% of patients in some moment of the foll ow up. Hepatic scintigraphy did not show significant changes. Hepatic histological alterations were mild and no changes were observed after two years of treatment. The main secondary effects were moderate and t ransitory gastrointestinal and hematological disturbances, The prednis one dose was decreased from 6.8 +/- 2.6 to 4.8 +/- 1.9 mg/day at twelv e months There were no withdrawals due to drug toxicity. It is conclud ed that methotrexate proved to be efficacious in the treatment of rheu matoid arthritis refractory to conventional treatments. Its secondary effects, although frequent, were discrete and transitory and there wer e no changes in liver histology.