Tahira Murtaza Cheema, Ghulam Murtaza Cheema, Rana Muhammad Arshad, Iqbal Bhutta.
Steroid sparing effect of Methotrexate and its hepatotoxicity in Rheumatoid Arthritis.
J Rawal Med Coll Jan ;8(2):72-4.

Background: To observe the safety of methotrexate in rheumatoid arthritis by monitoring serum albumin and transaminases and document decline in corticosteroid usage among the patients. Methods: This open prospective interventional study was carried out in the Departments of Orthopaedics and Medicine in Mayo Hospital, Lahore between 2000 and 2003. Twenty eight patients with chronic and persistent rheumatoid arthritis diagnosed according to the American Rheumatism Association 1987 revised criteria were included in the study. Both males and females within one year of onset of disease were included in this study. Methotrexate was started in a dose of 7.5mg per week with a maximum of 20mg per week. Simple analgesics and NSAIDs were given to control the symptoms. Corticosteroids were given to control symptoms and were subsequently tapered off to the lowest possible dose. Follow up period was 12 months for each patient. Results: The age of patients included in the study ranged from 18 to 59 years with a mean of 32.9 years. Male to female ratio was 1:3.1. Rheumatoid factor was present in 17 patients (60.71%). At the end of one year, the mean dose of prednisolone fell from 26mg to 1.63mg. Methotrexate dose ranged.from 7.5 to 20 mg per week (mean 18.9 mg) . The mean serum albumin levels fell from 43.1 gm/dl to 36.4 gm/dl. The mean AST levels rose from 17.8 units to 36.7 units per liter. No additional joint involvement occurred during the study period. No evidence of systemic complications of RA was noted in the patients. Range of movement of joints improved; swelling, redness and pain settled. Morning stiffness was completely abolished. No deformity developed in the patients during the study period and no radiological progression of the disease was noted. Conclusions: Methotrexate shows a sustained efficacy in rheumatoid arthritis. It decreases the concomitant use of steroids, NSAIDs and, analgesics. Hepatotoxicity is not common, especially if AST and serum albumin are carefully monitored and dosage adjustment made accordingly.

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