Methotrexate lacks efficacy in the treatment of severe ankylosing spondylitis compared with rheumatoid and psoriatic arthritis

Standard drug therapy in ankylosing spondylitis (AS) is based on nonsteroidal anti-inflammatory drugs. In severe, progressive, disabling cases, especially in cases with peripheral arthritis, long-acting, antirheumatic drugs have been used with some efficacy. Because of the lack of controlled trials, we treated 10 AS patients with a highly inflammatory disease course with methotrexate ((MTX) 10-15 mg/week by mouth). The efficacy and the clinical and serologic response to MTX were evaluated and compared with that in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients (n = 10 each) during 1 year prospectively in an open study. One-year data revealed an improvement in RA and PsA patients in all clinical and laboratory assessments, whereas no AS patients responded significantly to MTX therapy. Unlike in previous case reports and other recent findings, we did not find MTX effective in treating patients with severe, chronic, active AS. Whether MTX is helpful in early disease stages and more effective through parenteral administration has to be investigated in further prospective controlled trials.