PROGNOSTIC FACTORS FOR THE OUTCOME OF METHOTREXATE TREATMENT IN RHEUMATOID-ARTHRITIS

Aim of the study: To evaluate various symptoms/findings for their ability as prognostic markers in MTX-therapy in patients with rheumatoid arthritis. Patients and methods: 48 patients with definite RA were treated with MTX in a dose of 7,5 to 10 mg weekly for one year. Before MTX-therapy, six and twelve months after initiation of treatment the following examinations were recorded: duration of morning stiffness, grip strength, functional class according to Steinbrocker, Ritchie's Index, ESR, blood count, C-reactive protein, rheumatoid factor, antinuclear antibodies, electrophoresis, ALAT,ASAT, LDH, gamma-GT, alkaline phosphatase, uric acid, BUN, serum creatinine and urine analysis. In 29 patients additionnally IL-1 alpha, IL-1 beta, IL-2, sIL-2-R, IL-6, IL-8, IL-8AB and sCD-8 were determined at the start and after twelve months of treatment. Statistical analysis was performed by means of a standard SAS programme. Results: After one year 62,5% of the patients showed good or moderate improvement of the disease. In 11 patients minor side effects were observed, in 6 patients (12,5%) treatmet had to be terminated because of side effects. Good results with MTX were independent of duration of disease, sex, age, grip strength,joint score and seropositivity, but depended significantly on the functional capacity: patients with minor handicap had the greatest benefit from the treatment. Independent of the functional capacity patients with high levels of IL-1 beta and low levels of IL-8 antibodies both showed favourable results as well. Conclusion: The prediction of the outcome of a treatment with a disease modifying anti rheumatic drug in a single patient is highly desirable. For MTX it could well be worth studying IL-1 beta and IL-8-antibody levels in a larger group of patients before initiation of MTX therapy to confirm these preliminary results.