Methotrexate in chronic-recurrent calcium pyrophosphate deposition disease: no significant effect in a randomized crossover trial

Abstract

IntroductionCalcium pyrophosphate deposition (CPPD) may cause severe arthropathy, major joint destruction and treatment options are limited. The aim of this study was to test the therapeutic efficacy of methotrexate (MTX) in chronic or recurrent CPPD arthropathy.MethodsPatients with CPPD arthropathy were randomized to receive either weekly subcutaneous injections of 15 mg/week of MTX or placebo (PBO) for three months, in a double-blind, crossover randomized controlled trial. Inclusion criteria comprised definite CPPD disease, recurrent arthritis or persistent polyarthritis, and an insufficient response to NSAIDs, glucocorticoids or colchicine. The primary outcome was an improvement in the disease activity scores based on 44 joints (DAS44). The analysis was performed on an intent-to-treat basis.ResultsWe randomized 26 patients, and compared 25 treatment periods on MTX with 21 treatment periods on PBO. Baseline characteristics were balanced between the groups. The evolution of the DAS44 was not statistically significantly different between groups (median DAS44 decreased by −0.08 on MTX versus −0.13 on PBO, after three months, P = 0.44). Furthermore, pain levels remained stable in both groups (median change in VAS Pain −1 unit on MTX and 0 on PBO, P = 0.43), and none of the secondary outcomes was significantly different between the two groups. Minor adverse events (AE) did not differ in frequency between the groups, but the only serious AE occurred on MTX (bicytopenia).ConclusionsThe results of this trial with MTX in this older population with chronic or recurrent CPPD arthropathy suggest no strong effect of MTX on disease activity.Trial registrationEudraCT No: 2007-003479-37. Registered 26 April 2008

Use of Methotrexate in Patients With Calcium Pyrophosphate Crystal Deposition Disease

“…A. Finckh и соавт. [12] опубликовали результаты двойного слепого перекрестного рандомизированного контролируемого исследования, в котором не выявлено каких-либо преимуществ МТ по сравнению с плацебо: 26 пациентов с БДПФК попеременно получали либо МТ 15 мг/нед, либо плацебо в течение 3 мес с последующей за-меной одного препарата на другой (всего 25 курсов лече-ния МТ и 21 -плацебо) [12].…”

“…Тем не менее весьма скудные и противоречивые данные об эффек-тивности МТ при БДПФК [9][10][11][12] на настоящий момент не позволяют рассматривать его в качестве препарата первой линии терапии как альтернативу колхицину и НПВП.…”

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease Simulating Osteoarthrosis of the Knee: A Case Report

“…12 It is important to seek the most evidence-based practice approaches to treating patients with this condition. Unfortunately, the newest research suggests that there is no specific treatment to prevent or slow the progression of CPP deposition.…”

“…Unfortunately, the newest research suggests that there is no specific treatment to prevent or slow the progression of CPP deposition. 12 Although there is specific treatment, it is nonspecifically treated by nonsteroidal anti-inflammatory agents, glucocorticoids, or colchicine. However, these tend to be ineffective, particularly in recurrent or chronic cases.…”

“…However, these tend to be ineffective, particularly in recurrent or chronic cases. 12 CPPD disease is often misdiagnosed and frequently only treated symptomatically, which can lead to accelerated joint destruction. There has been little representation of conservative nonpharmaceutical therapy for CPPD.…”