Health Boards
Mon-24-06-2013, 13:59 PM
Below is translated with Google Translate and checked on correctness.
It shows a recent investigation in the Netherlands in which it is clear that MTX is useless when trying to beat PsA. But that doctors keep on prescribing.
The article can be read (in Dutch) at LINK REMOVED
MTX senseless with Arthritis Psoriasis
A double-blind randomized studies has shown no evidence that six months of treatment with methotrexate (MTX) is effective against synovitis in psoriatic arthritis (PsA). The researchers wonder whether MTX in PsA is effectively a DMARD.
The doctor who prescribes MTX in PsA, does something what many of his colleagues do too. He is even encouraged to do so by the guidelines, while the effectiveness of this treatment has not been conclusively proven. Nevertheless the NICE guidelines advise to try MTX before considering - well proven effective in PsA - TNF-alpha inhibitors.
British researchers therefore decided to put to test, which was not done before, the effect of MTX in PsA a randomized clinical trial (Rheumatology. 2012, 51 (8) :1368-77). The 221 participants had active PsA and were randomized to 15 mg MTX weekly or placebo. The primary outcome were the Psoriatic Arthritis Response Criteria (PsARC). Secondary outcome measures were the scores of ACR20 and DAS-28, and the seperate items in them.
44 participants, about equally divided between the two groups could not be involved in the follow-up, 26 participants discontinued treatment (14 in the MTX group). After six months no significant effect on PsARC (OR 1.77), nor on the ACR20 or DAS28 score (OR 2.00 respectively. 1,70) showed. Nor has there been significant positive effects of MTX on the number of tender and swollen joints, erythrocyte sedimentation rate (ERS), C-reactive protein (CRP), evaluation of health (HAQ score) and pain perception.
Although there was a trend towards improvement in MTX use, but none of the indices referred to this effect reached statistical significance. The only positive effects of MTX were an improvement of both the doctor and patient global scores and skin scores. The safety was as expected.
The authors conclude that the results do not indicate any improvement of synovitis in PsA by treatment with MTX. They recommended to practitionars that patients should be used with effective conventional means as leflunomide and biologicals.
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Additonal remarks from me... Biologicals can be very dangerous as part of the immune system is inhibited.
Instead, it is found that psorinovo (DMF) used with psoriatic arthritis (PsA) in 9 of the 10 cases gives disappearance and brings much less risk, if the recommended dose is not exceeded. This is demonstrated by including research in 2008 of dr. L. Kunst.
---------
Name Type dose price/year
Remicade infliximab 5 mg/kg 1 x per 2 months € 19.352.-
Humira adalimumab 1 x per week 40 mg € 32.480.-
Enbrel etanercept 2 x per week 50 mg € 28.260.-
Psorinovo DMF 6 x day 120 mg € 1.200,-
It shows a recent investigation in the Netherlands in which it is clear that MTX is useless when trying to beat PsA. But that doctors keep on prescribing.
The article can be read (in Dutch) at LINK REMOVED
MTX senseless with Arthritis Psoriasis
A double-blind randomized studies has shown no evidence that six months of treatment with methotrexate (MTX) is effective against synovitis in psoriatic arthritis (PsA). The researchers wonder whether MTX in PsA is effectively a DMARD.
The doctor who prescribes MTX in PsA, does something what many of his colleagues do too. He is even encouraged to do so by the guidelines, while the effectiveness of this treatment has not been conclusively proven. Nevertheless the NICE guidelines advise to try MTX before considering - well proven effective in PsA - TNF-alpha inhibitors.
British researchers therefore decided to put to test, which was not done before, the effect of MTX in PsA a randomized clinical trial (Rheumatology. 2012, 51 (8) :1368-77). The 221 participants had active PsA and were randomized to 15 mg MTX weekly or placebo. The primary outcome were the Psoriatic Arthritis Response Criteria (PsARC). Secondary outcome measures were the scores of ACR20 and DAS-28, and the seperate items in them.
44 participants, about equally divided between the two groups could not be involved in the follow-up, 26 participants discontinued treatment (14 in the MTX group). After six months no significant effect on PsARC (OR 1.77), nor on the ACR20 or DAS28 score (OR 2.00 respectively. 1,70) showed. Nor has there been significant positive effects of MTX on the number of tender and swollen joints, erythrocyte sedimentation rate (ERS), C-reactive protein (CRP), evaluation of health (HAQ score) and pain perception.
Although there was a trend towards improvement in MTX use, but none of the indices referred to this effect reached statistical significance. The only positive effects of MTX were an improvement of both the doctor and patient global scores and skin scores. The safety was as expected.
The authors conclude that the results do not indicate any improvement of synovitis in PsA by treatment with MTX. They recommended to practitionars that patients should be used with effective conventional means as leflunomide and biologicals.
---------
Additonal remarks from me... Biologicals can be very dangerous as part of the immune system is inhibited.
Instead, it is found that psorinovo (DMF) used with psoriatic arthritis (PsA) in 9 of the 10 cases gives disappearance and brings much less risk, if the recommended dose is not exceeded. This is demonstrated by including research in 2008 of dr. L. Kunst.
---------
Name Type dose price/year
Remicade infliximab 5 mg/kg 1 x per 2 months € 19.352.-
Humira adalimumab 1 x per week 40 mg € 32.480.-
Enbrel etanercept 2 x per week 50 mg € 28.260.-
Psorinovo DMF 6 x day 120 mg € 1.200,-
