Influence of methotrexate on radiographic progression in rheumatoid arthritis: a sixty-month prospective study

Clin Exp Rheumatol. 1997 May-Jun;15(3):263-7.


Objective: To evaluate if methotrexate (MTX) can slow disease progression, as determined radiographically, in comparison to other disease modifying drugs in rheumatoid arthritis (RA) patients.

Materials and methods: Pairs of hand and wrist radiographs from 30 patients treated with MTX and 30 treated with D-penicillamine (DP) were evaluated blindly and separately by two radiologists (A and B) using reference radiographs for scoring. A scale scoring similar to Larsen's standard radiographs with minor modifications was used. The radiographs studied were obtained at the beginning and 5 years after therapy in both groups.

Results: A significantly greater worsening was found in the DP-treated patients (p = 0.025), as compared to MTX patients. Methotrexate showed a slower rate of disease progression than DP. Furthermore, in the MTX group 15 patients remained radiographically stable, 9 worsened and 6 were healed. In contrast, in the DP group 22 patients remained radiographically stable, 8 worsened and none improved.

Conclusions: The rate of radiographic progression in RA patients was lower in MTX-treated patients compared to those treated with DP. Six patients showed radiological improvement after MTX treatment. Therefore, it seems that MTX could be considered a disease modifying drug.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / diagnostic imaging*
  • Arthritis, Rheumatoid / drug therapy*
  • Disease Progression
  • Female
  • Hand / diagnostic imaging
  • Humans
  • Longitudinal Studies
  • Male
  • Methotrexate / therapeutic use*
  • Middle Aged
  • Penicillamine / therapeutic use
  • Prospective Studies
  • Radiography
  • Wrist / diagnostic imaging


  • Antirheumatic Agents
  • Penicillamine
  • Methotrexate