Vol.19 No.6

Original Article

Prospective study of methotrexate treatment for rheumatoid arthritis treated legitimately according to the government recommended 8 mg/week dose

Authors

Akira Hashiramoto1 , Kazuko Shiozawa2 , Yasushi Tanaka2 , Takashi Yamane2 , Miki Murata2 , Chihiro Tanaka1,2 , Yasuhiro Terashima2 , Kozo Koyama2 , Natsuko Nakagawa2 , Shuji Abe2 , Rhosuke Yoshihara2 , Yasuhiro Saegusa3, Ken Tsumiyama4, Koichiro Komai4, Yoshitada Sakai1, Shunichi Shiozawa1,5

  • The Center for Rheumatic Diseases, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
  • Rheumatic Disease Center, Konan Kakogawa Hospital, 1545-1 Saijo, Kamino-cho, Kakogawa 675-854, Japan
  • Department of Orthopedics, Konan Hospital, 1-5-16 Kamokogahara, Higashinada-ku, Kobe 658-0032, Japan
  • Department of Biophysics, Kobe University Graduate School of Health Science, 7-10-2 Tomogaoka, Suma, Kobe 654-0142, Japan
  • Global Center of Excellence (G-COE), Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
Received:

17 March 2009

Accepted:

22 June 2009

Published online:

22 July 2009

Full Text

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Abstract

Clinical squeal of the treatment of rheumatoid arthritis patients with methotrexate (MTX) according to the Japanese government recommended dose of 8 mg/week was evaluated prospectively. A total of 176 patients with active RA attending Konan Kakogawa Hospital and Kobe University Hospital were enrolled. Patients’ profile at the start of study was Class 2.0 ± 1.1 and X-ray stage 2.6 ± 1.0. The effects of MTX treatment were evaluated by the American College of Rheumatology (ACR) core set, disease activity score of 28 joints (DAS28), and European League Against Rheumatism (EULAR) response criteria. A modified Sharp method was used to evaluate the radiographs. The improvement in the clinical signs and symptoms of the ACR core set was maintained for a 24-month period (p < 0.05). The ACR20/50/70 and DAS28 were also improved at the 12- and 24-month assessments. However, 82 of 130 patients (63.5%) were found to be nonresponders at 24 months of MTX therapy, as evaluated by EULAR response criteria. The X-ray study showed that joint destruction progressed despite the treatment. Thus, long-term MTX treatment performed in accordance with the Japanese 8 mg/week regimen appears to be favorable in terms of the signs and symptoms of RA; however, it is clearly insufficient for and cannot halt the progression of rheumatic joint destruction.

Key words

ACR core set - DAS 28 - EULAR response - Methotrexate - Rheumatoid arthritis