Arthritis drug may allow patients to reduced use of steroids

The question: Steroids are the treatment of choice for the widespread muscle pain and stiffness associated with the inflammatory disorder known as polymyalgia rheumatica. Because most people need to take the drugs for two years or longer, side effects become a concern. Might methotrexate, a rheumatoid arthritis drug, help wean people from the steroids?

This study randomly assigned 72 people newly diagnosed with polymyalgia rheumatica to take a weekly dose of either methotrexate or a placebo, along with a daily dose of the steroid prednisone. The steroid doses were reduced after four weeks, with the aim of stopping them after 28 weeks unless symptoms recurred. After 18 months, 87 percent of the people who took methotrexate were free of steroids, compared with 53 percent in the placebo group.

Who may be affected by these findings? Anyone with polymyalgia rheumatica, which is thought to be linked to the aging process because it rarely occurs before age 50.

Caveats: Overall, side effects were about the same in both groups, but those taking methotrexate had mild gastrointestinal problems more often than the others. The study did not last long enough to detect possible steroid side effects, which often do not occur until after 18 months. All participants took high doses of folinic acid to replace that depleted by methotrexate; however, this may have altered the effectiveness or side effects of the drug.

Bottom line: People with polymyalgia rheumatica may want to talk with their doctor about methotrexate.

Find this study in the October issue of Annals of Internal Medicine; abstract available online at www.annals.org.

Learn more about polymyalgia rheumatica at www.mayoclinic.com and at www.niams.nih.gov.