Methotrexate in the treatment of arthritis

NMUH Staff Publications

16

<span style="font-size: 10pt;">Methotrexate (MTX) is considered the cornerstone in the treatment of inflammatory arthritis, which affects many people living in care. Its efficacy was demonstrated in randomised controlled study carried out several years ago, both in adult and juvenile inflammatory arthritis (Lentendre, 1985; Petty et al, 2001). MTX was studied in further controlled trials and was reported to be the most common first line disease-modifying anti-rheumatic drugs (DMARD) treatment according to several treatment guidelines (Luqmani et al, 2009; Smolen, 2010; Singh et al, 2012). MTX exerts its disease modifying effect through inhibition of cell proliferation achieved via inhibition of de novo synthesis of purines and pyrimidine, essential for DNA and RNA synthesis. The anti-inflammatory effects of MTX are mediated by an increase of adenosine release (Kremer and Lee, 1986). Dose adjustment should be considered in older adult patients, especially those suffering from renal impairment. </span>