Methotrexate in systemic lupus erythematosus.

The most appropriate treatment of moderate, nonorgan threatening disease activity in systemic lupus erythematosus (SLE) remains poorly defined, although methotrexate (MTX) is commonly used. The results of 20 uncontrolled case series and a single retrospective cohort study tend to support its use to treat active skin and joint disease. Unfortunately, three prospective randomized trials have reported conflicting results. Two reported improvement in overall disease activity and decreased corticosteroid requirement with MTX. The third trial showed no benefit from MTX for disease activity, but did report a reduction in corticosteroid requirements. Difficulties in conducting trials in moderately active SLE are discussed.