Methotrexate therapy in the year 2000: Outstanding questions

Methotrexate (MTX) is the dominant drug worldwide in the therapy of rheumat oid arthritis (RA). Extensively studied over the past 20 years, it has been found to slow the rate of progression of erosion and joint narrowing in ma ny studies. Methotrexate has the ability to reduce doses of background ster oids and nonsteroidal antiinflammatory drugs, and it also has been associat ed with maintenance of a long-term clinical response. As a result, it has b ecome the anchor drug In almost every combination therapy regimen, as well as in trials with biological response modifiers. To date, no drug has consi stently outperformed MTX in a comparative trial. It is effective in patient s with all types of inflammatory arthritis and is relatively inexpensive co mpared with some of the newer treatments. Further-more, clinical trials sho w no difference in response between patients with early rheumatoid arthriti s and those with longstanding disease. In the United States, somewhere betw een 300,000 and 400,000 patients currently receive MTX, making it the most popular disease-modifying antirheumatic drug (DMARD) in the country.