Oral methotrexate linked to lower inflammation in knee OA after 3 months
Click Here to Manage Email Alerts
Patients with primary knee osteoarthritis who received at least 3 months of oral methotrexate demonstrated significant improvement in physical function and inflammation vs. patients who received glucosamine, noted a presenter at ACR 2020.
“Almost all patients with primary knee OA experience periods of warmth and swelling in the joint, with increases in pain and reduction of function,” Biswadip Ghosh, MD, from the Institute of Post Graduate Medical Education and Research in Kolkata, India, said in a press release. “Those episodes are inflammation, and every episode damages the structures of the knees a little more. After some time, swelling subsides partly due to burning out of materials.”
He added, “[This] leaves the knee in a hopeless state of function loss where physiotherapy helps minimally with enlistment for knee replacement. It will be helpful for patients if we can decrease the inflammation and rescue the joint.”
Although the current ACR recommendations do not favor MTX for OA, previous evidence has demonstrated that MTX may be useful. To assess the benefit of oral MTX on inflammation in primary knee OA, Ghosh and colleagues randomized patients (n=344) to receive either MTX (15-20 mg/week) or glucosamine (1,500 mg/day) as a placebo for 3 months.
The researchers recruited patients with primary knee OA of both sexes, aged 40 to 65 years, who exhibited swelling and pain of both knee joints for at least 6 months with radiographic OA. Patients with a Kellgren-Lawrence (KL) grade of 4, secondary OA, diabetes, renal or hepatic disease, gout, arthroscopy or intra-articular injections in the previous 3 months were excluded from the study.
The researchers assessed patients for signs of local inflammation, including pain and swelling of the knee, and evaluated them for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels.
According to study results, patients who received MTX for 3 months demonstrated significant improvements in WOMAC scores, ESR and CRP, while patients who received glucosamine reported no significant improvement in function or inflammation.
“Treatments offered to patients with primary knee OA are usually physical support and knee replacement, which are basically directed to manage the effect of the disease,” Ghosh said. “Our study provides hope to patients not only from this inexpensive molecule, methotrexate, but other therapies directed towards one cause of the disease: inflammation. We should think of using methotrexate if we find signs of both local and systemic inflammation in patients with primary knee OA when conventional therapies are not helpful. Additionally, more research should be directed towards the inflammatory pathways of the disease in the future.”
Collapse
Ghosh M. Abstract #1648. Presented at: ACR Convergence 2020; November 5-9, 2020 (virtual meeting).
Read more about
Click Here to Manage Email Alerts