The impact on disability of initial treatment with methotrexate in patients with rheumatoid arthritis: results from the MARI study

Abstract

The study aimed to assess in a population of subjects with rheumatoid arthritis (RA) treated with methotrexate (MTX) how the initial approach to the treatment influenced subsequent disability. We performed a cross-sectional analysis of data collected during the baseline visit of the MARI study, a multicenter observational study on patients with RA on treatment with MTX for at least 12 months. Subjects who fulfilled the Health Assessment Questionnaire (HAQ) were included in the evaluation. For every patient we retrospectively evaluated the disease duration, the duration of symptoms before the diagnosis, the time elapsed before first MTX treatment, the initial MTX dose, and the concomitant medications in the first six months of therapy. Disability was defined as a DI-HAQ score ≥1. The study population included 1015 subjects. Patients with a DI-HAQ score ≥1 had a longer duration of symptoms before diagnosis, a higher delay in treatment initiation, a lower initial dose of MTX and a more frequent co-treatment with symptomatic drugs. Disability was found less frequently in subjects treated with other concomitant disease modifying anti-rheumatic drugs (DMARDs) but not with biological agents. Logistic regression analysis identified as significant predictors of disability: older age, female sex, a longer time to complete diagnosis, a delay in starting MTX treatment higher than 6 months, and a concomitant treatment with symptomatic drugs, while a combination therapy with other DMARDs was associated with a lower risk of disability. A late diagnosis and a delay in starting a treatment with MTX are associated with poorer functional outcomes in patients with RA.

Obesity and methotrexate treatment failure in rheumatoid arthritis patients in Cipto Mangunkusumo Hospital, Indonesia

“…Third, other classes of DMARDs (conventional, targeted, and biologic) have less efficacy when used as monotherapy than when combined with methotrexate [10]. Fourth, in addition to having good efficacy and good safety profile, economically, the price is also relatively cheaper than other therapeutic modalities [11], [12]. Methotrexate is recommended as a first-choice drug by various international and national organizations such as the European League Against Rheumatism (EULAR), American College of Rheumatology (ACR), Asia Pacific League Against Rheumatism (APLAR) and Indonesia Rheumatology Association (IRA) [13]- [16].…”