Can treatment with methotrexate influence the radiological progression of rheumatoid arthritis?

We have recently reported that methotrexate (MTX) is an effective treatment of patients with refractory rheumatoid arthritis (RA) to second line medication. We showed that 54% of our patients continued having clinical benefit after 24 months therapy with MTX. In this study we evaluated pairs of hand radiographs from 35 patients taken before and after 24 months treatment. We used a scale scoring similar to Larsen's standard radiographs with minor modifications. No significant changes were observed in the overall scoring of the radiographs before (14.84 +/- 13.05) and after treatment (18.77 +/- 15.60) (p greater than 0.5). Of these 35 patients, 23 had a clinical remission and 12 had a good response. Twenty patients have shown a stabilization of erosions in radiographs while 15 showed a deterioration. No correlation was found between clinical response and radiological changes. We conclude that MTX does not appear to be a disease modifying agent, but may inhibit joint damage progression.