EDITORIAL - PsA, MTX and the liver - are rheumatologists putting their patients at risk?

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Rheumatology Advance Access originally published online on May 12, 2008

Rheumatology 2008 47(7):939-941; doi:10.1093/rheumatology/ken158

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EDITORIALS

Psoriatic arthritis, methotrexate and the liver—are rheumatologists

putting their patients at risk?

K. and A. Gough

Harrogate and District NHSFT, Harrogate, N Yorkshire, UK

It seems hard to believe that in the early 1990s MTX use by a

respected group of UK rheumatologists in nine hospitals only

represented 3% of all DMARDs used for a cohort of patients presenting

with early RA [1]. It is now the most widely used DMARD, not only for

RA, but is effective for both psoriasis and PsA [2, 3]. It has also

become our principal anchor drug in combination therapy, including the

anti-TNF agents, where recent data suggests that their combination is

our best treatment option yet in RA [4]. As a cheap, effective and

usually well-tolerated drug it is not surprising that prescribing it

worldwide has continued to rise exponentially and that the patients

may be on it commonly for >5 yrs.

Hepatotoxicity with MTX has always been a concern. In the 1970s, this

was the predominant reason for MTX falling out of favour in the UK.

Fortunately for patients, good long-term follow-up studies continued

in the USA proving not only that it is safe but also that it may

improve survival in patients with RA [5, 6]. Further data shows that

it is more likely to be continued at 5 yrs than any of the traditional

DMARDs and is now the most frequently prescribed in Europe too [3].

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Read the rest of the editorial here:

http://rheumatology.oxfordjournals.org/cgi/content/full/47/7/939

Not an MD