Efficacy of methotrexate in the treatment of ankylosing spondylitis: A three-year open study

The aim of the study was to evaluate the efficacy of methotrexate treatment in patients with ankylosing spondylitis in a 3-year open trial. Seventeen patients, 14 men and three women (mean age 32.7 +/- 8.9 years), suffering f rom ankylosing spondylitis and non responders to treatment with sulphasalaz ine, were enrolled in our study. Sixteen of them were evaluable at the end of the study. Methotrexate (7.5-10 mg/week) was administered for 3 years. E fficacy was evaluated on the basis of clinical and laboratory variables, ra diographic signs of disease progression and daily dosage of indomethacin. W e obtained a good and relatively prompt clinical response except for periph eral arthritis and iridocyclitis; in fact, after 3 months of methotrexate t reatment a significant amelioration of the following parameters was observe d: visual analogue scale for the evaluation of both night pain and general well-being, Shober's test. occiput-wall distance. fingertip to floor, eryth rocyte sedimentation rate, C-reactive protein level and daily dose of indom ethacin. A further improvement was obtained during the subsequent period. R adiographs of the spine and sacroiliac joints did not show any signs of dis ease progression. Side-effects were a transitory elevation of transaminases (four cases) and slight hypogammaglobulinaemia (one case). Methotrexate tr eatment may be useful in ankylosing spondylitis, but a combined treatment m ight be indicated for patients with peripheral arthritis.