The effect of age on methotrexate efficacy and toxicity.

We studied the clinical course of 235 patients with rheumatoid arthritis (RA) receiving methotrexate (MTX) over a mean of 1.9 years. Both older (greater than 65 years) and younger (less than or equal to 65 years) patients demonstrated clinical improvement, but older patients had greater improvement in erythrocyte sedimentation rate and hemoglobin than younger patients. Most assessments of laboratory abnormalities and symptoms suggestive of toxicity did not differ between age groups. But more gastrointestinal complaints and pulmonary complaints were reported in older patients, associations that have been noted in older patients not treated with MTX as well. Our data indicate that treatment that includes MTX is effective in older patients with RA, and that older patients improve at least as much as younger.