EFFECTS OF LOW-DOSE METHOTREXATE ON THE BONE-MINERAL DENSITY OF PATIENTS WITH RHEUMATOID-ARTHRITIS

Objective. To determine the effects of low dose methotrexate (MTX) on bone mineral density (BMD) of patients with rheumatoid arthritis (RA). Methods. We examined the relationship between BMD and disease modifyi ng antirheumatic drug (DMARD) use with data from a prospective, random ized, placebo controlled trial assessing the effects of calcium and vi tamin D-3 supplementation on BMD of patients with RA. Measurements of BMD of the lumbar spine and femoral neck were performed at baseline an d at yearly followup visits over 3 years.Results. Information about DM ARD use and BMD was available for 133 patients at baseline, and for 95 patients at Year 3. Lumbar spine and femoral neck BMD of MTX and non- MTX treated patients were similar at the start of the study. At the en d of 3 years of followup, there were no significant differences in the change in BMD of the femoral neck and lumbar spine in MTX and non-MTX treated patients, in general. However, patients treated with predniso ne greater than or equal to 5 mg/day plus MTX had greater loss of BMD in the lumbar spine than patients treated with a similar dose of predn isone without MTX (difference -8.08% over 3 years; p = 0.004). Conclus ion. At the end of 3 years, low dose MTX use was not associated with c hange in femoral neck or lumbar spine BMD in patients who were not tre ated with corticosteroids. However, among patients treated with predni sone greater than or equal to 5 mg/day, combined treatment with MTX an d prednisone was associated with greater bone loss in the lumbar spine than treatment with prednisone without MTX.