Safety of low dose methotrexate in elderly patients with rheumatoid arthritis

Weekly low dose methotrexate is an established treatment for rheumatoid art hritis, but its use in elderly people has not been adequately examined. The aim of this study was to evaluate its safety in elderly patients with rheu matoid arthritis. A retrospective review of the clinical records of rheumat oid arthritis patients over the age of 65 attending a rheumatology unit was conducted. Eligible patients were followed for at least two years and trea ted with methotrexate in a dose of 7.5 mg/week while being maintained on co ncurrent treatment. Thirty three patients were studied. Their mean age was 78.8 years; 32 were female and one was male. Treatment was discontinued in four patients, two because of raised serum liver enzymes and two because of gastrointestinal irritation. No serious adverse events were reported. Afte r two years, haemoglobin levels increased from a mean (SD) of 12.4 (1.3) g/ dl to 13.0 (1.1) g/dl (r = 0.226, p < 0.005). The white blood count was sig nificantly reduced from 7.9 (1.8) x 10(9)/1 to 6.8 (1.7) x 10(9)/1 (r = 0.1 84, p < 0.05). No episodes of neutropenia or agranulocytosis were observed. There was a nonsignificant decrease in platelet count. The erythrocyte sed imentation rate decreased from 56.8 (30.8) to 35.2 (24.6) mm/h (r 0.246, p < 0.01). In conclusion, low methotrexate treatment in elderly patients appe ars to be safe. Routine determination of serum liver enzymes and renal func tion may reduce individual risk.