Effect of low dose methotrexate as an add-on therapy in patients with palindromic rheumatism unresponsive to hydroxychloroquine: An observational study.

Abstract

Palindromic rheumatism (PR) is characterized by repetitive attacks of arthritis and/or periarthritis. There is inadequate data regarding the role of low dose methotrexate in patients with PR. The aim of this study was to determine the efficacy of low dose methotrexate add-on therapy in patients withPR with inadequate response to hydroxychloroquine (HCQ) monotherapy. In this observational study, between August 2016 and July 2019, 15 patients with seropositive PR with inadequate response to HCQ (≥ 2attacks per month even after 6 months of therapy) were included. All patients were treated with oral low dose methotrexate in addition to HCQ. The responses to therapy were monitored 3 and 6 months after adding methotrexate. In our study, of the 15 patients with PR, two-third were female, with a mean age of 45.73±9.18 years. All were seropositive (Rheumatoid factor positive in eight patients; anti-cyclic citrullinated peptide [CCP] positive in 11 patients; both Rheumatoid factor and anti-CCP positive in four patients). The average number of attacks at baseline was 5.6±2.8, and the median duration of attacks was 2 years. All patients had significant response to add-on methotrexate therapy at follow-up after 3 and 6 months; none developed Rheumatoid arthritis (RA) after 2 years of follow-up. Low dose methotrexate is an effective add-on therapy in patients with PR having inadequate response to HCQ.