Methotrexate in the treatment of ankylosing spondylitis

The authors carried out an open prospective study analyzing methotrexate (M TX) efficacy and toxicity in 34 patients with ankylosing spondylitis (AS) f or a period of one year. All the patients presented with active axial disea se, characterized by inflammatory spinal pain, prolonged morning stiffness, erythrocyte sedimentation rate(ESR) greater than or equal to 25 mm, and fa ilure on treatment with non-steroidal anti-inflammatory drugs for a period of more than two years. MTF; was taken at a single weekly intramuscular dos e of 12.5,ng. Thirty-one patients (91%) concluded treatment. Eighteen patie nts (53%) were considered responders to MTX; most of them presented periphe ral arthritis. Despite clinical improvement, axial measures were unaltered at the end of the study. The mean value of ESR decreased significantly at t he end of the treatment (p=0.0001), predominantly in the responders group. Side effects were observed in 23 patients (68%) and included dyspeptic synd rome. transient elevation of liver enzymes, and dizziness. The results of t his one year open study suggest that MTX can be an efficient drug in the tr eatment of AS.