B. Ostendorf et al., METHOTREXATE LACKS EFFICACY IN THE TREATMENT OF SEVERE ANKYLOSING-SPONDYLITIS COMPARED WITH RHEUMATOID AND PSORIATIC-ARTHRITIS, Journal of clinical rheumatology, 4(3), 1998, pp. 129-136
Standard drug therapy in ankylosing spondylitis (AS) is based on nonst
eroidal anti-inflammatory drugs. In severe, progressive, disabling cas
es, especially in cases with peripheral arthritis, long-acting, antirh
eumatic drugs have been used with some efficacy. Because of the lack o
f controlled trials, we treated 10 AS patients with a highly inflammat
ory disease course with methotrexate ((MTX) 10-15 mg/week by mouth). T
he efficacy and the clinical and serologic response to MTX were evalua
ted and compared with that in rheumatoid arthritis (RA) and psoriatic
arthritis (PsA) patients (n = 10 each) during 1 year prospectively in
an open study. One-year data revealed an improvement in RA and PsA pat
ients in all clinical and laboratory assessments, whereas no AS patien
ts responded significantly to MTX therapy. Unlike in previous case rep
orts and other recent findings, we did not find MTX effective in treat
ing patients with severe, chronic, active AS. Whether MTX is helpful i
n early disease stages and more effective through parenteral administr
ation has to be investigated in further prospective controlled trials.