REVIEW - An update on methotrexate

[Guest guest]

Curr Opin Rheumatol. 2009 May;21(3):216-23.

An update on methotrexate.

Braun J, Rau R.

Rheumazentrum Ruhrgebiet, Landgrafenstr 15, Herne 44652, Germany.

PURPOSE OF REVIEW: Methotrexate (MTX) has been used for the treatment

of rheumatoid arthritis (RA) for about three decades now. MTX is one

of the most effective and commonly used medicines to treat various

forms of arthritis and other rheumatic conditions. MTX was shown to

improve signs and symptoms of RA, disease activity and function, to a

similar degree as the tumor necrosis factor blockers, and it inhibits

radiographic progression to a smaller degree than the antitumor

necrosis factor agents. MTX is considered as the anchor drug among the

disease-modifying antirheumatic agents, and it is internationally

accepted as the first choice in the management of RA. This review was

performed on the basis of a PubMed literature search looking at all

publications on MTX and arthritis in 2008.

RECENT FINDINGS: MTX seems to even prolong the life span of patients

who tolerate the drug and have clinical benefit from this therapy;

this may partly be explained by beneficial effects on cardiovascular

mortality. The reason for this may well be the suppression of

inflammation, but direct atheroprotective effects of MTX may also play

a role. MTX is used as monotherapy and in combination with other

disease-modifying antirheumatic agents or biologic agents such as the

antitumor necrosis factor agents. The 'early' use of MTX within 5

years after disease onset is clearly associated with improved

outcomes. The management of RA should include an early strong

suppression of inflammation and continuously a tight control strategy.

The pharmacodynamics and kinetics of MTX are still incompletely

understood.

SUMMARY: In this review, we especially cover the following themes: new

clinical studies on the use of MTX in RA, the use of MTX in other

rheumatic conditions, prediction of response to MTX, optimal dosage,

MTX use in the elderly, the mechanism of action, the pharmacokinetics

and the pharmacogenetics of MTX, the prevention of side effects, and

the overall long-term safety.

PMID: 19373092

http://www.ncbi.nlm.nih.gov/pubmed/19373092

Not an MD

[Guest guest]

(not an MD - L0L:)) Thank you for this posting, it is very informative.  My

experience is that doctors are great, but they dont know everything and you have

to find what works for you as an individual.

 

I have a dear friend, a professor of Oriental Medicine who is now finding out

what Chinese Herbal concoction will work best in conjunction with these meds. 

Most of the prescriptions are for teas.  I am not sure how acupuncture can

affect bone changes associated with RA.  I will report back to you if you are

interested on what combination of herbs he suggests. 

 

Thanks, i am glad I found this group.

 

Fondly

OKD

From: <Rheumatoid.Arthritis.Support@...>

Subject: [ ] REVIEW - An update on methotrexate

" " < >

Date: Tuesday, June 2, 2009, 9:57 AM

Curr Opin Rheumatol. 2009 May;21(3):216-23.

An update on methotrexate.

Braun J, Rau R.

Rheumazentrum Ruhrgebiet, Landgrafenstr 15, Herne 44652, Germany.

PURPOSE OF REVIEW: Methotrexate (MTX) has been used for the treatment

of rheumatoid arthritis (RA) for about three decades now. MTX is one

of the most effective and commonly used medicines to treat various

forms of arthritis and other rheumatic conditions. MTX was shown to

improve signs and symptoms of RA, disease activity and function, to a

similar degree as the tumor necrosis factor blockers, and it inhibits

radiographic progression to a smaller degree than the antitumor

necrosis factor agents. MTX is considered as the anchor drug among the

disease-modifying antirheumatic agents, and it is internationally

accepted as the first choice in the management of RA. This review was

performed on the basis of a PubMed literature search looking at all

publications on MTX and arthritis in 2008.

RECENT FINDINGS: MTX seems to even prolong the life span of patients

who tolerate the drug and have clinical benefit from this therapy;

this may partly be explained by beneficial effects on cardiovascular

mortality. The reason for this may well be the suppression of

inflammation, but direct atheroprotective effects of MTX may also play

a role. MTX is used as monotherapy and in combination with other

disease-modifying antirheumatic agents or biologic agents such as the

antitumor necrosis factor agents. The 'early' use of MTX within 5

years after disease onset is clearly associated with improved

outcomes. The management of RA should include an early strong

suppression of inflammation and continuously a tight control strategy.

The pharmacodynamics and kinetics of MTX are still incompletely

understood.

SUMMARY: In this review, we especially cover the following themes: new

clinical studies on the use of MTX in RA, the use of MTX in other

rheumatic conditions, prediction of response to MTX, optimal dosage,

MTX use in the elderly, the mechanism of action, the pharmacokinetics

and the pharmacogenetics of MTX, the prevention of side effects, and

the overall long-term safety.

PMID: 19373092

http://www.ncbi.nlm.nih.gov/pubmed/19373092

Not an MD

------------------------------------

[Guest guest]

Hi, OKD. My signature includes " Not an MD " because, in the distant

past when I have offered my opinion on controversial subjects here, I

was told that I wasn't " even a doctor! " LOL. Now I have a disclaimer

for all to see.

I wouldn't abandon traditional DMARDs for " alternative " treatments. As

adjunctive treatment though, alternative therapy is often employed.

I'm not aware of any study which demonstrates that acupuncture retards

or prevents erosions. There is no proof that anything but DMARDs will

prevent disease progression in rheumatoid arthritis.

Early, aggressive treatment of RA with DMARDs is extremely important

and leads to higher rates of remission and better outcomes.

Please do share what you learn from your friend.

Not an MD

On Tue, Jun 2, 2009 at 9:12 AM, Robin (OKD) <Cofade_2000@...> wrote:

>

>

> (not an MD - L0L:)) Thank you for this posting, it is very

> informative.  My experience is that doctors are great, but they dont know

> everything and you have to find what works for you as an individual.

>

> I have a dear friend, a professor of Oriental Medicine who is now finding

> out what Chinese Herbal concoction will work best in conjunction with these

> meds.  Most of the prescriptions are for teas.  I am not sure how

> acupuncture can affect bone changes associated with RA.  I will report back

> to you if you are interested on what combination of herbs he suggests.

>

> Thanks, i am glad I found this group.

>

> Fondly

>

> OKD

[Guest guest]

Thanks, I cant see how acupuncture could prevent bone changes or erosions

either, however, I can see how herbs can.  Its not that I am anti-anything, but

doctors are not the be all and end all, and someone who has an open mind, who

goes out and seeks, for themselves what works, and most assuredly one who LIVES

IT, can certaintly go tit for tat with an MD.   I will stand up for my beliefs,

no matter what degree somebody has.  I betcha you could go toe to toe with any

rheumatologist, coudnt you?

 

I believe that one must truly be spiritual grounded to deal with this, listen to

their head, explore alternative remedies in combination with what the " white

coats " prescribe.

 

Everything cant be about pills, pills and more pills, and then you take a pill

to deal with another pills, its an endless, horrible, viscous drug cycle.  Right

now I personally am on 5 meds, and another one to be added, with my drug

prescription plans, these " designer " drugs, which some have no generic equiv.

are $35.00 a pop, the generics $12.00.  Thats alot of moolah, when you have kids

in college, hard economic times, etc......so I am seeking out alternatives, and

I KNOW they are out there. 

OKD

>

>

> (not an MD - L0L:)) Thank you for this posting, it is very

> informative.  My experience is that doctors are great, but they dont know

> everything and you have to find what works for you as an individual.

>

> I have a dear friend, a professor of Oriental Medicine who is now finding

> out what Chinese Herbal concoction will work best in conjunction with these

> meds.  Most of the prescriptions are for teas.  I am not sure how

> acupuncture can affect bone changes associated with RA.  I will report back

> to you if you are interested on what combination of herbs he suggests.

>

> Thanks, i am glad I found this group.

>

> Fondly

>

> OKD

------------------------------------