Survival Benefit For RA Patients Taking Methotrexate Therapy

October 12, 2002

10/04/2002

There are a number of effective treatments for rheumatoid arthritis that

improve arthritis symptoms and decrease the destruction of joints affected

by the disease. Of these, methotrexate is the most frequently prescribed

³disease-modifying² therapy. Increasingly, however, researchers are studying

the long-term consequences of RA on overall health. Rheumatoid arthritis

often affects many parts of the body other than the joints. There is now

evidence that people with RA have increased rates of heart disease,

infections and certain types of cancer. Overall, these illnesses contribute

to poor health and even a decrease in overall life expectancy for people

with RA. Thus, while the benefits of methotrexate for arthritis symptoms are

well known, it has remained unclear if this, or any treatment for RA, can

improve overall health and lead to a normal life expectancy.

To address the question of whether RA therapy can impact life expectancy, a

group of researchers tracked RA patients over an extended period of time‹an

average of six years‹and compared life expectancy for those receiving

methotrexate with those not taking methotrexate. Their findings were

reported in a recent publication in the journal Lancet1. In all, they

studied 1,240 patients over two decades, from 1981 to 1999. Approximately

half of these patients were treated with methotrexate. In general, those

patients who took methotrexate tended to have more severe disease activity.

Analysis of life expectancy demonstrated a significant impact from treatment

with methotrexate: patients taking methotrexate had a 60% reduction in

mortality, after adjusting for disease severity. Notably, deaths due to

heart disease were reduced by 70% in patient on methotrexate. This survival

increase was specific for methotrexate and was not seen in patients treated

with other medications used in the study (including sulfasalazine,

penicillamine, hydroxychloroquine and gold).

From these results, the researchers suggest that in addition to providing

effective treatment for arthritis, methotrexate may provide a substantial

benefit to overall health for RA patients, particularly in regard to

cardiovascular disease. The authors caution that despite the length and size

of this study, it has some limitations. Nonetheless, these findings provide

useful information for patients and physicians regarding the long-term

benefits of the most commonly prescribed medication for RA.

Reference:

1 Choi, H.K. et. al. ³Methotrexate and mortality in patients with

rheumatoid arthritis: a prospective study.² 2002. Lancet 359:1173.

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