Current Methotrexate Use Research Articles

Pregnancy outcomes and contraceptive use in women with rheumatoid arthritis

Rheumatoid arthritis (RA) is a common chronic autoimmune disorder that has a female predominance and commonly affects women of childbearing age, it is shown to remit during pregnancy in most studies and improve in about half of the patients when assessed with objective disease activity measurements. To assess the pregnancy outcomes in women with rheumatoid arthritis prior and after diagnosis and compare it with women with no chronic illness. To evaluate contraceptive practices and correlated contraceptive method efficacy with use of concomitant rheumatic medications. (Methotrexate, leflunomide). A total of 100 female patients diagnosed with rheumatoid arthritis according to ACR/EULAR 2010 classification criteria were compared with apparently healthy female controls matching in age in this case- control study. Data was collected by questionnaires and interview. The questionnaires included demographic data and pregnancy outcomes, mode of delivery, contraceptive methods used by patients with the current use of methotrexate and leflunomide. The mean age for the patients and controls were 38.4+5.1 and 36.7+4.5 years respectively. The live births significantly decreased in female patients with rheumatoid arthritis in compare with controls and before diagnosis (p 0.010, p 0.002 respectively).

Variation of homocysteine levels in rheumatoid arthritis patients: relationship to inflammation, cardiovascular risk factors, and methotrexate.

The aim of this study was to evaluate the variation of homocysteine (Hcy) levels in patients with rheumatoid arthritis (RA) and to analyze the relationship to inflammatory parameters, cardiovascular risk, and methotrexate (MTX). This cross-sectional study assessed disease activity and treatment in RA patients. The European League Against Rheumatism (EULAR) 2015 HeartSCORE was performed for cardiovascular (CV) risk estimation and levels of plasma Hcy, serum folate concentrations, vitaminB12, and erythrocyte sedimentation rate (ESR) were measured. A total of 103participants with mean age 53 ± 10years and mean disease duration 10.55 ± 7.34years were included. Patients were treated with MTX in 69.9% of cases and corticosteroid in 80.5% of cases. Of all patients, 13% had acardiovascular inheritance, 25% were hypertensive, and 18% had diabetes. The EULAR 2015 HeartSCORE was high and very high (≥5%) in 35% of cases. Mean Hcy level was 12.54 ± 4.2 µmol/L [6.89-32.92] and hyperhomocysteinemia was noted in 20.4% of patients. Analytic study demonstrated that hyperhomocysteinemia was associated with male gender (p = 0.01), MTX use (p = 0.01), smoking (p = 0.008), renal failure (p = 0.04), and high disease activity (p = 0.05), but there was no association with the HeartSCORE (p = 0.23). Hcy level was negatively correlated with folate (p = 0.009) and vitaminB12 level (p = 0.02) and positively with age (p = 0.01), C‑reactive protein (CRP; p = 0.05), and Simplified Disease Activity Index (SDAI; p = 0.03). In multivariate logistic regression analysis, current MTX use, levels of vitaminB12 and creatine, and Clinical Disease Activity Index (CDAI) appeared to be independent factors associated with hyperhomocysteinemia. MTX use, CDAI, and the levels of vitaminB12 and creatine are independent factors associated with hyperhomocysteinemia.

Left ventricular myocardial strain assessed by cardiac magnetic resonance feature tracking in patients with rheumatoid arthritis

PurposeThe aim of the study was to assess a relationship between the occurrence of rheumatoid arthritis (RA) and its selected clinical parameters, and left ventricular myocardial strain.Material and methodsFifty-six subjects were qualified for the study: 30 RA patients and 26 subjects without rheumatoid diseases. The study design included taking medical history, assessment of the disease activity using selected scales of activity, collecting samples of venous blood to assess selected laboratory parameters and the assessment of cardiac magnetic resonance (CMR). Using the feature tracking method, the following parameters of the left ventricular myocardial strain were assessed: longitudinal strain (LS), radial strain (RS) and circumferential strain (CS).ResultsRegarding global values, peak LS and peak CS were statistically significantly lower in RA patients than in the control group. In the whole study group, the factors independently related to low global LS peaks were as follows: occurrence of RA, occurrence of arterial hypertension, increased activity of antibodies against cyclic citrullinated peptide and increased concentration of neutrophil gelatinase-associated lipocalin. The occurrence of RA, occurrence of diabetes, tobacco smoking, higher activity of antibodies against cyclic citrullinated peptide and current use of methotrexate are the risk factors for low peak of global CS. The current use of steroids constitutes a protecting factor against low global CS peaks.ConclusionIn subjects with no clinically manifested cardiac damage, RA is associated with a deteriorated left ventricular systolic function assessed by left ventricular myocardial strain measured by CMR feature tracking.

Rheumatoid arthritis-related lung disease detected on clinical chest computed tomography imaging: Prevalence, risk factors, and impact on mortality

ObjectiveWe aimed to determine the real-world prevalence and investigate risk factors for rheumatoid arthritis (RA)-related lung disease on chest computed tomography (CT) imaging. We also investigated the impact of RA-related lung disease on mortality. MethodsWe studied chest CT imaging abnormalities among RA patients. We determined the presence and type of abnormalities using the chest CT imaging radiologic report. RA-related lung disease was defined as interstitial lung disease (ILD), bronchiectasis, or pleural disease. We examined whether demographics and RA characteristics were associated with RA-related lung disease using logistic regression. RA-related lung disease and mortality was described using survival curves and Cox regression. ResultsWe analyzed 190 patients who had chest CT imaging performed for clinical indications. Mean age was 64.2 years (SD 11.8), 80.0% were female, and 75.3% were seropositive. RA-related lung disease was detected in 54 patients (28.4%); 30 (15.8%) had ILD, 27 (14.2%) had bronchiectasis, and 18 (9.5%) had pleural disease. RA-related lung disease was reported in both seropositive and seronegative RA (28.7% vs. 27.7%, p = 1.00). Male sex (OR 2.62, 95%CI 1.17–5.88) and current methotrexate use (OR 2.73, 95%CI 1.27–5.61 vs. not current) were associated with RA-related lung disease. Twenty-four (44.4%) patients with RA-related lung disease died during mean 7.0 years of follow-up. RA-related lung disease had HR of 5.35 (95%CI 0.72–39.9) for mortality compared to normal chest CT. ConclusionsIn this real-world study, RA-related lung disease was commonly detected on chest CT imaging regardless of RA serostatus. RA-related lung disease had high mortality, emphasizing the importance in close monitoring of these patients.

Coronary and Abdominal Aorta Calcification in Rheumatoid Arthritis: Relationships with Traditional Cardiovascular Risk Factors, Disease Characteristics, and Concomitant Treatments

To assess the influence of traditional cardiovascular (CV) risk factors, disease characteristics, and concomitant treatments in patients with rheumatoid arthritis (RA) on coronary artery calcification (CAC) and abdominal aorta calcification (AAC). In our cross-sectional study, 75 patients with RA were compared with 75 age-matched and sex-matched control participants. The CAC and AAC scores were measured by computed tomography in patients with no clinical evidence of coronary artery disease. The relationships between the presence or absence of CAC and AAC and traditional CV risk factors, disease characteristics, and concomitant treatments in patients with RA were assessed in a multiple logistic regression analysis. The RA and control groups did not differ significantly in terms of age, sex composition, or the prevalence of traditional CV risk factors. AAC and CAC were more prevalent and severe in patients with RA than in controls. Older age (OR=1.15, p<0.01) and hypertension (OR=3.77, p=0.04) were found to be independently associated with CAC, whereas current use of methotrexate (MTX; OR=0.12, p=0.01) was found to be associated with the absence of CAC. Older age (OR per yr=1.17, p<0.001) and erosive arthritis (OR=3.78, p=0.03) were found to be independently associated with AAC. Our study demonstrates that in patients with RA, (1) CAC and AAC are more prevalent and more severe compared with age-matched and sex-matched control participants, (2) current use of MTX is a major determinant of the absence of CAC, and (3) erosive arthritis is a major determinant of AAC.

SAT0160 Coronary and Abdominal Aorta Calcification in Rheumatoid Arthritis: Relationships with Traditional Cardiovascular Risk Factors, Disease Characteristics and Concomitant Treatments

BackgroundPatients with rheumatoid arthritis (RA) are exposed to accelerated atherosclerosis and a substantially elevated risk of cardiovascular events (especially coronary heart disease) and death. However, this morbi-mortality cannot be fully...

OP0004 Assessing Methotrexate Compliance in Rheumatoid Arthritis

BackgroundWorldwide, methotrexate (MTX) is considered the first-line disease-modifying antirheumatic drug treatment for patients with rheumatoid arthritis (RA). MTX compliance among patients with RA may be influenced by MTX response, adverse...

SAT0148 Cardiovascular Risk Estimation in Rheumatoid Arthritis: What is Missing in Traditional Risk Estimators?

BackgroundCardiovascular (CV) disease is one of the major causes of mortality in RA. Although the CV risk in RA is well-recognized, detection of high risk patients and prevention of CV...

Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA)

BackgroundPatients with rheumatoid arthritis (RA) are at increased risk of developing comorbid conditions.ObjectivesTo evaluate the prevalence of comorbidities and compare their management in RA patients from different countries worldwide.MethodsStudy design:...

THU0338 Incidence of selected opportunistic infections among children with juvenile idiopathic arthritis

BackgroundThere may be an increased risk of opportunistic infections among children with juvenile idiopathic arthritis (JIA), especially with exposure to immunosuppressant medications. No controlled studies to address this question have...

Semiquantified Noncalcified Coronary Plaque in Systemic Lupus Erythematosus

A major cause of morbidity and mortality in systemic lupus erythematosus (SLE) is accelerated coronary atherosclerosis. New technology (computed tomographic angiography) can measure noncalcified coronary plaque (NCP), which is more prone to rupture. We report on a study of semiquantified NCP in SLE. Patients with SLE (n = 147) with no history of cardiovascular disease underwent 64-slice coronary multidetector computed tomography (MDCT). The MDCT scans were evaluated quantitatively by a radiologist, using dedicated software. The group of 147 patients with SLE was 86% female, 70% white, 29% African American, and 3% other ethnicity. The mean age was 51 years. In our univariate analysis, the major traditional cardiovascular risk factors associated with noncalcified plaque were age (p = 0.007), obesity (p = 0.03; measured as body mass index), homocysteine (p = 0.05), and hypertension (p = 0.04). Anticardiolipin (p = 0.026; but not lupus anticoagulant) and anti-dsDNA (p = 0.03) were associated with higher noncalcified plaque. Prednisone and hydroxychloroquine therapy had no effect, but methotrexate (MTX) use was associated with higher noncalcified plaque (p = 0.0001). In the best multivariate model, age, current MTX use, and history of anti-dsDNA remained significant. Our results suggest that serologic SLE (anti-dsDNA) and traditional cardiovascular risk factors contribute to semiquantified noncalcified plaque in SLE. The association with MTX is not understood, but should be replicated in larger studies and in multiple centers.

Imatinib in active diffuse cutaneous systemic sclerosis: Results of a six‐month, randomized, double‐blind, placebo‐controlled, proof‐of‐concept pilot study at a single center

To better understand the feasibility of using imatinib, a tyrosine kinase inhibitor, to treat active diffuse cutaneous systemic sclerosis (dcSSc). We performed a 6-month, randomized, double-blind, placebo-controlled, proof-of-concept pilot study of imatinib in patients with active dcSSc. Data on safety, modified Rodnan skin thickness scores (MRSS), Health Assessment Questionnaire (HAQ) scores, patient's and physician's global assessments (100-mm visual analog scale), and biomarkers in serum and skin biopsy samples were collected. We used a 4:1 randomization strategy (imatinib 200 mg administered twice a day versus placebo), stratifying according to current use of methotrexate. The plan was to enroll 20 dcSSc patients. After enrolling 10 patients (9 receiving active drug and 1 receiving placebo), we found poor tolerability and high rates of adverse events with imatinib, and study enrollment was discontinued. There was no significant difference in the mean MRSS in all patients who took imatinib (31.1 at baseline versus 29.4 at 6 months) or in only those who completed 6 months of imatinib (31.0 at baseline versus 30.3 at 6 months), and there was no difference in the C-reactive protein level, erythrocyte sedimentation rate, physician's global assessment, patient's global assessment, response to the Health Transition query, or the HAQ scores between those who did and those who did not complete 6 months of therapy. Side effects were edema, fluid retention, fatigue, nausea, cramps/myalgias, diarrhea, alopecia, and anemia. Most side effects occurred within the first week of treatment, and even when imatinib was reintroduced at a lower dosage (200 mg daily), it was poorly tolerated. Two patients were hospitalized because of side effects of the medication. In general, biomarker levels in plasma and skin did not change. Imatinib was poorly tolerated, and this could limit its application in SSc. The study was too small to form conclusions about the efficacy of imatinib in SSc.

87: Clinical and Ultrasonographic Predictors of Ruptured Ectopic Pregnancies: Preliminary Results from the Detroit Medical Center Ectopic Database

87: Clinical and Ultrasonographic Predictors of Ruptured Ectopic Pregnancies: Preliminary Results from the Detroit Medical Center Ectopic Database

An audit of the use of methotrexate in a dermatology department

Methotrexate is commonly used for the treatment of psoriasis. It has potentially serious side-effects and effective monitoring is essential. We conducted an audit to compare our current use of methotrexate with established guidelines and to highlight areas for improvement. The case notes of 40 patients on maintenance treatment with methotrexate were reviewed. There were inadequacies in documentation of alcohol history, baseline investigations and test dose of methotrexate. The riming of liver biopsies was not always based on cumulative dose of methotrexate. Information given to patients and general practitioners was felt to be inadequate. As a result of the audit, standard forms have been introduced to document details at the start of treatment, monitoring investigations and cumulative methotrexate dose. Information for patients and general practitioners have been designed and are used regularly. Increased awareness should result in increased patient compliance and earlier hospital referral should side-ef...

Accidental ingestion of methotrexate

Two siblings ingested an unknown amount of methotrexate and, although they were treated with a folinic acid preparation within 3 hours, serum levels of SGOT and LDH were elevated within 24 hours. No other signs of toxicity developed. The elimination of methotrexate from the body was slow, and 13 days after ingestion the drug was measurable in plasma of each child. Because of the current use of methotrexate in the treatment of skin disorders, the drug is now more available for accidental ingestion by children. Prompt administration of folinic acid (Leucovorin) is important, if severe toxicity is to be avoided.