Effectiveness of methotrexate therapy with occasional corticosteroid in rheumatoid arthritis

Abstract

Background: Rheumatoid arthritis is an immunologically driven chronic synovitis showing heterogeneity in disease progression, treatment, and variability of response to therapy. This study investigated the effectiveness of methotrexate, folic acid, and vitamin C for treatment of patients with rheumatoid arthritis. Methods: The effects of methotrexate with folic acid, vitamin C, and an occasional steroid were analyzed in 62 patients with rheumatoid arthritis selected on the basis of American College of Rheumatology (ACR) criteria, before and after 24 wk of therapy on (1) lipoprotein profile, (2) Disease Activity Score (DAS)-28, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and (3) oxidative stress. Results: After 24 wk of therapy, the response rates were ACR70 in 72% (45), ACR50 in 21% (13), and ACR20 in 7% (4). The median initial DAS-28-CRP of 5.2 was reduced to 2.5 and median VAS of 7.7 was reduced to 2.4. Assuming normality in the control data, the power of the analysis was 92%. The mean level of low-density lipoprotein-cholesterol (LDL-c), total cholesterol, malondialdehyde, CRP, and triglycerides were significantly (P<0.05) higher, but blood pressure, uric acid, and creatinine were normal in RA patients at baseline. Significant improvements in level of high-density lipoprotein-cholesterol (HDL-c), total cholesterol, CRP, malondialdehyde, and triglycerides were observed in rheumatoid patients treated with methotrexate. At baseline, CRP positively correlated with total lipids (r=0.28, P<0.05) and total cholesterol (r=0.64, P<0.01). Total cholesterol was negatively correlated with HDL-c (r=−0.40, P<0.01). The blood pressure and liver function tests were within normal range at 4 yr follow-up. Conclusions: Methotrexate combination therapy was effective in (1) reducing disease activity, (2) improving rest pain and morning stiffness, and (3) improving lipid profile due to suppression of inflammation. However, whether or not it is capable of lowering or eliminating cardiovascular disease risk requires further investigation as morbidity and mortality are higher in patients with rheumatoid arthritis compared to the general population.