Ann Intern Med

Methotrexate for knee osteoarthritis?

August 20, 2024

Adding oral methotrexate to usual medications showed a statistically significant reduction in knee osteoarthritis (OA) pain, stiffness, and function at 6 months.

• This multicenter, double-blind, placebo-controlled RCT included 155 participants (64% women; mean age, 60.9 years) with radiographic knee OA and knee pain (severity ≥4 out of 10) most days in the past 3 months, with inadequate response to medication. Sites included 15 UK musculoskeletal clinics; the trial spanned 2014–2017. Patients were randomly assigned 1:1 to oral methotrexate once weekly (6-week escalation 10 mg to 25 mg) vs. matched placebo for 12 months; usual analgesia was continued. Knee pain was measured via a rating scale.
• At 6 months, knee pain had decreased from a mean of 6.4 at baseline to 5.1 with methotrexate, vs. 6.8 to 6.2 with placebo. A statistically significant reduction in pain rating of 0.79 points favored methotrexate (p = 0.030). Western Ontario and McMaster Universities Osteoarthritis Index stiffness and function also favored methotrexate. An adherence analysis supported a dose-response effect.
• There were 2 unrelated serious adverse events in each group.

Source:

Kingsbury SR, et al. (2024, July 30). Ann Intern Med. Pain Reduction With Oral Methotrexate in Knee Osteoarthritis : A Randomized, Placebo-Controlled Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/39074374/