METHOTREXATE LACKS EFFICACY IN THE TREATMENT OF SEVERE ANKYLOSING-SPONDYLITIS COMPARED WITH RHEUMATOID AND PSORIATIC-ARTHRITIS

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.