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Rheumatoid Arthritis Drug Also Prolongs Life

Methotrexate found to have an added benefit

THURSDAY, April 4, 2002 (HealthDayNews) -- People with rheumatoid arthritis who take methotrexate to ease their stiffness may be getting an additional benefit from the drug: longer life.

A new study shows that methotrexate cuts the overall risk of early death by 60 percent -- and slashes the odds of fatal heart and vessel illness by even more -- compared with not using the drug.

Although it's not clear why, people with the joint ailment often suffer hardening of the arteries and cardiovascular disease. Methotrexate, which is also prescribed to treat certain cancers and to induce abortions, may control these problems enough to prevent their life-threatening complications like heart attacks and strokes, experts said. It may also simply improve symptoms enough to get people active and living healthier lifestyles, with a subsequent profit to longevity.

Dr. John H. Klippel, medical director of the Arthritis Foundation, called the new results "very important."

"I think is just further evidence that [methotrexate] has effects that go well beyond improving joint inflammation and swelling," Klippel said.

The findings are reported in the April 6 issue of The Lancet.

Methotrexate is the leading drug therapy for people with rheumatoid arthritis, a crippling autoimmune condition that affects more than 2 million Americans, roughly 60 percent of whom are women. The inflammatory disease typically sets in during middle age, striking joint lining and other tissue.

Over any 10-year period, people with rheumatoid arthritis have about twice the odds of dying -- usually succumbing to cardiovascular diseases and serious infections like pneumonia -- as those without the disorder.

While low-dose methotrexate has been the standard of care for rheumatoid arthritis for a decade, doctors haven't known if the drug saves lives. The latest work, the largest study yet to address the question, suggests the answer to that question is yes.

A team led by Dr. Frederick Wolfe, a University of Kansas joint specialist and director of the Arthritis Research Center Foundation in Wichita, followed 1,240 men and women with rheumatoid arthritis who'd sought treatment for their condition at a Wichita outpatient clinic.

Beginning in 1981, roughly half the patients received methotrexate (many of those who didn't enrolled in the study before the drug became a widespread treatment for arthritis). The rest were offered other arthritis treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs).

People who got the more potent medication tended to have worse arthritis than the other patients. But even after adjusting for the severity of their disease, those on methotrexate were much more likely to be alive at the end of the study than those who didn't receive the drug. Of the 191 deaths that occurred among the subjects between 1981 and 1999, 72 were in the methotrexate group vs. 119 among the rest of the patients.

The bulk of methotrexate's protective effect appeared to be its ability to reduce the risk of deadly cardiovascular complications, which were 70 percent less likely in people who received the drug. But it also cut the odds of dying from infections, too.

Other arthritis treatments may offer short-term relief, but Wolfe said the long-term survival benefit from methotrexate "sets the standard for what we should be aiming for."

Methotrexate is considered generally safe. However, it can in rare cases lead to serious side effects that include liver disease, lung injury and even certain cancers.

What To Do

To learn more about rheumatoid arthritis, try the Arthritis Foundation or the Rheumatoid Arthritis Information Network.

And for more on the use of methotrexate to treat joint problems, try this page from the New Zealand Rheumatology Association.

SOURCES: Frederick Wolfe, M.D., Arthritis Research Center Foundation, Wichita, Kan.; John H. Klippel, M.D., medical director, Arthritis Foundation, Atlanta; April 6, 2002 The Lancet
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