Advantages of starting with high dose methotrexate treatment in rheumatoid arthritis on the control of the disease

Advantages of Starting with High Dose Methotrexate Treatment in Rheumatoid Arthritis on the Control of the Disease When not treated properly, Rheumatoid arthritis (RA) progresses in its chronic course, joint damage increases, and it can even lead to systemic involvement. In the course of time, insufficiently treated patients develop a loss of function and work capacity and RA results in disability. The severity of the illness leads to the advancement of new agents and treatment modalities in RA treatment. Methotrexate (MTX), having an effectiveness and reliability proven long time ago, is the most preferred drug in RA treatment. However; there is no agreement among physicians on the dose of methotrexate. The aim of this study was to determine the effects of high dose methotrexate use in the initial combined therapy on the activity of illness among active RA patients. The study included 45 patients newly diagnosed with RA or those who did not use illness modifying drugs in the last 3 months. Patients were divided into two groups randomly. First group received 12.5 mg/week MTX intramuscularly in the first 4 weeks and later, continued orally. Second group received 25 mg/week MTX intramuscularly in the first 4 weeks and continued with 12.5 mg/week orally. Beside the MTX treatment, 2 gr/day sulfasalazine and 5 mg/day prednisolone were given to both groups. At three different stages of the treatment (the start, first month and third month) patients were evaluated in terms of "disease activity score 28" (DAS28), "modified health assessment questionnaire" (MHAQ), general health evaluation with "visual anolog scale" (VAS), morning stiffness, erythrocyte sedimentation rate and C-reactive protein, renal and liver function tests. Although scores of first month did not show a significant difference between the two groups, scores of third month in the high dose MTX group exhibited a marked improvement in all criteria except morning stiffness when compared to normal dose group. Improvements in DAS28 scores and number of sensitive joints were statistically significant. ACR 20, 50, 70 and 90 improvements of third month in the high dose MTX group were higher than those of the normal dose group. The differences for ACR70 and ACR90 were statistically significant. Findings of this study demonstrated that usage of high dose MTX at an early stage is more effective in controlling the illness activity and increases the quality of life in RA. Key Words: Methotrexate, Rheumatoid Arthritis, Combined Therapy