Monday 4 April 2011

Efficacy of Methotrexate - Who Knows?

Methotrexate wasn't initially intended for treating arthritis. In fact, it's first use was in treating leukemia and was used a chemotherapy drug for a long time. It is certified for use in treating auto-immune disorders, such as psoriatic arthritis, but nobody really knows how effective it is.

Psoriatic arthritis tends to manifest itself in 3 main ways:

  1. Inflammation of the synovial bursa - This is inflammation of the joint itself, the stereotypical symptom of an arthritis.
  2. Inflammation of the tendon sheath - The tendon sheath is similar to the membrane surrounding the joint and can become inflamed in the same way. This is what causes tendinitis and the dactylitis that's so typical of PsA.
  3. Inflammation of the entheses - Enthesitis is inflammation at the point where the tendon meets the bone. It's different in nature to the synovial inflammations.

Rheumatologists are pretty confident prescribing methotrexate for arthropathies that involve synovial and tendon issues. It works. They have the evidence. What nobody has conclusively tested is whether methotrexate can improve the condition of enthesitis.

In two weeks time I should hopefully be part of a trial that hopes to discover whether methotrexate is effective, and exactly how effective it is. The trial is based purely on taking accurate measurements and adjusting treatment according to those measurements rather than just following best practice guidelines. This is what evidence based medicine should really be.
Posted by Unknown at 13:02
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3 comments:

  1. Iorch27 April 2011 at 08:47

    Hello Daniel,

    This is Jorge from Madrid. I've just read your WHOLE blog. I cannot
    feel more identified with you. I'm also a guitar player, well, not
    professional, but I've been playing since my early teens. I've even
    thought about being a professional, but I've been suffering of several hand
    pains since my mid twenties.

    Right now, I'm struggling to get a proper diagnosis,but it's not an easy task.
    I've had so far three appointments with three rheumatologists, two of them through private health care.
    All the time I get the same statement : "All your issues are related to hand overuse".But they do not
    explain why my feet issues, why my hip issues. They just rely on the fucking RF blood test coming negative,
    -very low ESR and CRP doesn't help at all neither- so what can I do? How the HECK do I, an 29 year old computer
    analyst, without any medical background,convice that I may have Psoriatic arthritis (without psoriasis) or
    seronegative rheumatoid arthritis? I'm so desesperate.So far I've had a hand MRI showing Flexor tenosynovitis. Rheumatologists says that the tenosynovitis
    is not active (???) , and that tenosynovitis usually is due overuse. Well, go and read some abstracts
    and you will find out that flexor tenosynovitis is HIGHLY specific of Rhematic disseases like PsA or RA,
    I would bet my flying V guitar that I have one of those two. I currently waiting for my follow with my
    last rheumatologist. He ordered me 4 months ago a battery of blood tests -No Anti CCP, seriously? I had to
    order a privetely paid blood test, anti cpp came negative-

    I need to convice him, I cannot keep this untreated. Symptoms are getting more intense, I'm keepin' them at
    bay through lots of exercising. Having my GF saying that it's all on my head doesn't help at all.

    But,for sure, I won't hang on my guitar!!! Shawn Lane made my day. If he had those skills with P. arthritis...I guess not everything is lost.

    Sorry for my english...Really hoping that MTX helps you.

    ReplyDelete
  2. Unknown29 April 2011 at 14:25

    I'm really sorry to hear that your hands are troubling you. The first rheumatologist I saw basically diagnosed me with over use but less than a week later I had a proper diagnosis from someone that knew what they were doing.

    I also have quite low ESR. It's only very slightly above normal. One of the diagnostic measures I had was an injection of steroids to see if it reduced the pain I was feeling all over my body. This was a clear indication that I did have inflammation but that it just wasn't showing up well.

    The problem with Psoriatic Arthritis is that it's essentially diagnosed by a method of excluding everything else. There are some fairly clear markers, such as sausage fingers. You need to keep a good log of all of these. Also what times of day you feel pains most. That's normally the first question they ask.

    All I can say is good luck finding out what was wrong. I am very lucky to have an amazingly supportive girlfriend and I'm sure yours will come round once you know what's really going on.

    ReplyDelete
  3. Unknown15 September 2018 at 08:30

    Methotrexate, a folate antagonist, is a potent anti-inflammatory agent when used weekly in low concentrations, the anti-phlogistic action of which is due to increased adenosine release at inflamed sites. Methotrexate

    ReplyDelete

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