Well-Designed Trial: MTX Improves Knee OA

Is methotrexate a good option for knee osteoarthritis? A commentary finds that the study supporting the idea provides good evidence in its favor.

Hart LE. Methotrexate reduced pain and improved function in symptomatic knee osteoarthritis. Ann Intern Med. (2014) 161(4):JC6. 19 August 2014. doi:10.7326/0003-4819-161-4-201408190-02006

This Journal Club reviews the Egyptian study, Methotrexate in the treatment of symptomatic knee osteoarthritis: randomised placebo-controlled trial (Ann Rheum Dis, doi:10.1136/annrheumdis-2013-204856), which found that methotrexate (MTX) significantly improved pain, synovitis and physical function in knee osteoarthritis with modest adverse effects (See Rheumatology Network's earlier report, Methotrexate Eases Pain, Synovitis in Knee OA).

Although OA is categorized as a degenerative joint disease, synovial inflammation is a key component. The lack of new therapies is frustrating, says this commenter from Ontario.

Therefore, this trial is welcome, he says. It is a robust, well-designed randomized, blinded trial with 144 patients over 28 weeks that adds to two smaller, earlier, open-label studies with less conclusive results.

It shows that MTX can reduce pain, reverse active synovitis, and improve physical function in patients with knee OA.

The primary outcome, change in pain, was reduced on the Visual Analog Scale by 11 points more in the MTX group than the placebo group (26 points vs 15 points).