Methotrexate for ankylosing spondylitis

Chen J, Liu C, Lin J

Summary

Methotrexate for ankylosing spondylitis

This summary of a Cochrane review presents what we know from research about the effect of methotrexate for ankylosing spondylitis. The review shows that:

There is silver level evidence (www.cochranemsk.org) that for people with ankylosing spondylitis, methotrexate may not improve overall disease activity, physical function, overall pain, pain, tenderness and swelling in the ligaments of the joints, movement of the spine, stiffness or overall well being. It may not cause serious side effects. But there is not enough evidence to be certain of the benefits and harms of methotrexate for ankylosing spondylitis and more research is needed.

What is ankylosing spondylitis and what drugs are used to treat it?
Ankylosing spondylitis (AS) is a type of arthritis, usually in the joints and ligaments of the spine. It may also affect the shoulders, hips, or other joints. Pain and stiffness occurs and limits movement in the back and in other joints that are affected.

Non steroidal anti-inflammatory drugs (NSAIDs) are usually used to stop the pain and stiffness. When people do not do well with NSAIDs, disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate, are sometimes prescribed. It is not known whether methotrexate controls pain and stiffness in AS, slows the progress of AS, or can stop joint damage.

What are the results of this review?
Benefits of methotrexate
In people with ankylosing spondylitis, at 6 to 12 months, methotrexate

may not improve overall disease activity, physical function, overall pain, pain, tenderness or swelling in the ligaments of the joints, movement of the spine, stiffness and overall well being. But there is not enough evidence to be certain.

Damage to the spine as seen on x-ray was not measured and therefore it is not known whether methotrexate slows damage.

Harms of methotrexate
In people with ankylosing spondylitis, at 6 to 12 months, methotrexate may not cause serious side effects. But there is not enough evidence to be certain. Side effects may include nausea, stomach pain, vomiting, mild diarrhea, mild headaches, mouth sores, changes in liver function, hair loss or mild infections.