To summarise, the evidence indicates MTX can have a role in alleviating symptoms, however it has no statistically significant DMARD effect in terms of lowering inflammation or preventing damage.
The study notes that this is in contrast to TNF-alpha blockers that have many studies demonstrating their disease-modifying qualities.
MTX did show a significant effect in reducing area and severity of P.
There are a number of studies showing an increase of effectiveness of the biologics when used in conjunction with MTX (along with longer time of effectiveness)
There is also a number of studies showing that the control of the P results in fewer symptoms of PsA.....
Many Docs are willing to skip the MTX "step" (mine for one) except the folks paying are not. I am private pay.
Also the MTX was not used according to protocol in this study. The "triple hit" is now the standard. It involvers DMRD, NSAID, and Steroids. No steroids were allowed in the study group.
Stoney said:
Thanks for sharing this. So when will the doctors get on board with this?
I first noticed in Enbrel's prescribing guide that MTX increases the effectiveness of Enbrel, but it's just with RA. There's nothing on the combination with PsA.
Yes Lamb, I know that steroids were excluded, but to me that’s the point. My PsA is great on lots of steroids, but everything else falls apart. My Rhuemy was happy for me to be taking them until I insisted on a bone scan and it showed a pattern that clearly indicated steroid related bone density loss over less than 8 months…
Still my Rhuemy didnt organize a biologic - you probably remember me agonizing over paying for it myself (no special payment plan in Aus). It took me to pay for it a couple of months and prove that it worked before he finally relented and filled out the little forms…
So Stoney, I agree with Lamb , the rhuemys won’t get on board any time soon.
This is just information to help PsA people to choose the way they approach things. I realize not everyone is in the same position to do exactly the same thing finacially, but for example, I think I’d still be battling with MTX (doing very little) plaquenil (doing nothing) and NSAIDs (occasionally have some positive impact on spine, nothing on major joints or peripheral), if I hadn’t made the decision for myself that a biologic was the most likely option to provide the best improvement at lowest risk, and figured out how to go about it.
Andrew, I havent stopped to check, but by memory you are right - they are RA studies (though there are some other studies that seem to indicate concomitant MTX reduces any antibody reaction, incuding in PsA… Not good enough evidence for me to take it If Enbrel works ok without it :).
The thing is, the Rheumys are all petrified of biologics, in a way that only healthy people can be.