LOW-DOSE METHOTREXATE IN THE TREATMENT OF WIDESPREAD MORPHEA

Background: Low-dose methotrexate (MTX) has been shown to be effective in the treatment of systemic sclerosis. Objective: We evaluated the e ffect of low-dose MTX on widespread morphea in a 24-week trial. Method s: Oral MTX, 15 mg/week, was administered to nine patients. Clinical r ecords (modified skin score [MSS], durometer score, and the scores on a visual analogue scale (VAS) of feelings of tightness and itching), a s well as laboratory data were examined. Serum aminoterminal propeptid e of type III procollagen (PIIINP) was determined at weeks 0, 12, and 24. Results: At the end of the 24-week treatment period, significant i mprovement: was observed in MSS (P = .01) and the VAS score for tightn ess (P < .01), whereas the durometer score (P = .07) and the VAS for i tching (P = .07) showed a tendency toward improvement. PIIINP level di d not alter. No serious adverse events were noted. Conclusion: These r esults suggest a beneficial effect of MTX on widespread morphea. Becau se spontaneous improvements are not uncommon, prospective double-blind , placebo-controlled studies are necessary to determine the usefulness of MTX in this disease.