Rheumatoid Drug May Prolong Life

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Rheumatoid Drug May Prolong Life

Thu Apr 4, 6:02 PM ET

By EMMA ROSS, AP Medical Writer

LONDON (AP) - Methotrexate, a key drug for rheumatoid arthritis, could

help people with the crippling disease live longer, new research

suggests.

Methotrexate, originally a cancer drug, has been used to fight rheumatoid

arthritis for about 15 years. Since then it has been proven to slow

progression of the inflammatory disease and to make patients feel better,

but a new study provides the first hint it may also save lives.

Experts said the study, published this week in The Lancet medical

journal, was encouraging but did not provide definitive proof.

Rheumatoid arthritis strikes about 1 percent of people, usually in middle

age.

People with the disease tend to die about 10 years sooner than normal,

according to Dr. Theodore Pincus, a prominent rheumatoid arthritis

researcher from Vanderbilt University in Nashville, Tenn.

It is not the type of arthritis common in the elderly because of the

wear-and-tear of aging. It occurs when the immune system goes awry and

attacks the joints, causing severe inflammation in the lining of the

joints, pain and stiffness. It is also linked to an increased risk of

heart disease.

Scientists believe people with rheumatoid arthritis have shorter life

spans partly because they face increased chances of getting heart disease

and dying from it.

The latest study, led by Dr. Frederick Wolfe of the Arthritis Research

Center Foundation at the University of Kansas School of Medicine, found

that patients on methotrexate were 60 percent less likely to die

prematurely than those not getting the drug.

They were 70 percent less likely than people not on the drug to die from

heart disease.

Experts said that finding bolsters the growing body of evidence that

inflammation might play a role in heart attacks and that anti-

inflammatory medication might ward them off.

Methotrexate works by switching off the underlying inflammation caused by

the immune response.

Dr. , professor of clinical rheumatology at Guy's, King's and

St. ' Medical School in London, said the survival findings echo

what doctors have suspected.

" If you go back 20 years when people had little treatment for their

rheumatoid arthritis, they did very badly. Death was common, " said ,

who was not connected with the research. " There's no doubt that nowadays

it seems a lot better, inasmuch as not so many people seem to be dying

and patients seem to be doing a lot better overall. "

The biggest change in the last decade in rheumatoid arthritis has been

the widespread use of methotrexate, he said.

" This would seem to be a drug treatment effect, but you can never be

certain that it isn't that the disease is getting milder, " he said.

Part of the uncertainty comes from the way the study was conducted, other

experts said.

It involved 1,240 people with rheumatoid arthritis seen at a specialist

arthritis center between January 1981 and December 1999.

A total of 588 of the patients were put on methotrexate, at their

doctors' discretion. Those more ill tended to get the drug.

By the end of the study, 191 of the patients had died, 72 of whom were on

methotrexate.

Wolfe adjusted his statistics to take account of the fact that the

methotrexate group was sicker, but experts say the study's method could

not rule out that factors other than methotrexate could have been at

work.

A more robust approach is to randomly assign patients to either

methotrexate or a dummy pill so that not even the doctors know who's had

what.

" He's adjusted for all the confounders that he can think of, " said Dr.

Marc Hochberg, head of rheumatology and clinical immunology at the

University of land School of Medicine. " But you still wouldn't be

comfortable concluding, based on this one study, that methotrexate is the

reason that the patients have a lower mortality rate. "

Hochberg noted that studies designed similarly to this one had shown that

estrogen therapy was linked with a lower risk of heart disease death in

post-menopausal women, but that when researchers finally tested the idea

by randomly giving estrogen and dummy medication, no death prevention was

apparent.

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