Rheumatoid arthritis is a chronic inflammatory disease which results in reduced life-expectancy and is associated with cardiovascular disease, infection, and cancer. Low-dose methotrexate is the main choice of antirheumatic therapy for rheumatoid arthritis, although its effect on mortality for patients with the disease is not known.

Hyon Choi from Harvard Medical School and Harvard School of Public Health, Frederick Wolfe from University of Kansas School of Medicine, USA, and colleagues prospectively studied 1240 patients with rheumatoid arthritis over the past two decades. 191 individuals died during follow-up. Patients who began treatment with methotrexate (around half of the study population) had more severe rheumatoid arthritis. After adjustment for this confounding factor, methotrexate was found to have a 60% survival benefit for all-cause mortality compared with those who did not use methotrexate, and a 70% survival benefit for cardiovascular death.

Hyon Choi comments: Our data indicate that methotrexate may provide a substantial survival benefit, largely by reducing cardiovascular mortality. This gain in life expectancy could be considered in selecting a cost-effective, disease-modifying antirheumatic drug on a long-term basis. Additionally, the survival benefit of methotrexate would set a standard against which new disease-modifying antirheumatic drugs should be compared.

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Lancet
4-Apr-2002