Abstract

METHOTREXATE TOXICITY IN RHEUMATOID ARTHRITIS TO SHRINK ON EARLY DIAGNOSIS AND TREATMENT: A PROSPECTIVE OPEN LABEL STUDY

Mahalakshmi A.M*, Subhashini V, Ramesh B. Nidavani, B. Suresh

ABSTRACT

To categorize the functional status of Rheumatoid arthritis (RA) patients based on American College of Rheumatology (ACR) revised criteria, to assess the nephrotoxicity and safety profile of Methotrexate (MTX) in RA, to study the incidence of anaemia in RA patients undergoing MTX regimen and to measure the clinical response in RA patients receiving MTX using Disease Activity Score 28 (DAS28) based on ESR. A prospective open label trial was conducted for a period of 6 months from June 2010 to February 2011. The study medication MTX of 7.5 mg/week and 10mg/week was given for class II and class III RA patients respectively. The significant reduction in morning stiffness, number of swollen joints, number of tender joints, ESR (Erythrocyte sedimentation rate), VAS (Visual analogue scale) and DAS 28 in both class II and class III patients denotes decrease in inflammation as well as severity of RA. Reduction in DAS 28 value by 1.6 differences indicates that there is good response to medication. In class II the decrease in DAS28 to value below 3.2 indicates that treatment with MTX is not required for the RA. Reduction in hematological, biochemical and electrolyte parameters was significant but as the values remained within the normal range there was no severe anemia and nephrotoxicity found. In view of good performance and high accuracy found in this study, the 1987 ACR criteria was useful for the diagnosis of RA in an early stage of arthritis and to minimize the toxicity profile of the MTX.

Keywords: Rheumatoid arthritis; Methotrexate; Disease activity score; Visual analogue scale; American College of Rheumatology.